More and more women are choosing not to take hormonal therapy after menopause as studies show an association between hormone therapy and the risk of breast cancer. Unfortunately, the decline in estrogen levels that naturally occurs with menopause can cause uncomfortable vaginal dryness. This can not only make sex uncomfortable, but can cause vaginal irritation, soreness, and itching. Although there is a hormone vaginal cream containing estrogen available, many women choose not to use this option because of the fear of estrogen being absorbed and potentially increasing their breast cancer risk. Is there truth to this? Is a hormone vaginal cream likely to be absorbed by the body?
The hormone vaginal cream generally prescribed for vaginal dryness is prescription strength Premarin vaginal cream. Like the oral form of Premarin it contains conjugated estrogens, similar to oral hormone therapy. This cream is applied directly to the vaginal area to help relieve the itching and irritation associated with loss of estrogen. It’s generally used every day for three weeks and then stopped for a week. This cycle is usually continued as long as the symptoms continue to be a problem. Most women experience significant symptom relief with the use of this hormone vaginal cream.
What about absorption of the estrogens? Hormone vaginal cream such as Premarin cream appears to be well absorbed into the blood stream. In a study published in JAMA, it was shown that the estrogens in this cream quickly and effectively enter the blood stream. This means estrogen cream could exert similar effects to taking hormonal therapy by mouth, although it’s unlikely that blood levels would be as high as when hormone replacement therapy is used in pill form. Most sources admit that the long term effects of using a hormone vaginal cream aren’t known.
What should you do if you’re experiencing vaginal dryness and irritation, but don’t want the risks of systemic estrogen exposure? In some cases, if you’re at low risk for breast cancer, it may be safe to use hormone vaginal cream short term until the vaginal irritation clears since it appears that most concern about the use of estrogens centers around long term use. Some women have been successful avoiding the use of hormone vaginal cream entirely and, instead, using vitamin E oil or vitamin E suppositories to soothe irritated tissue. Be aware that this can cause further irritation in some women. You can also use a water based lubricant before sex to give additional lubrication. Some studies have also shown that a phytoestrogen rich diet can help to relieve vaginal dryness.
The bottom line? If you’re concerned about the risks of hormone vaginal cream, talk to your doctor about other options that might be available to you Together you can come up with a treatment plan that will work without increasing your risk of breast cancer.