Using Vaginal Estrogen to Combat Vaginal Dryness

Women undergoing cancer treatment, especially those suffering from gynecologic cancer and breast cancer, will tell you that vaginal dryness can be a bothersome side effect of treatment. Surgery, chemotherapy, radiation therapy and hormonal therapy can interfere with the body's production of natural vaginal lubrication. The result is mild to severe vaginal dryness that can make sexual intercourse painful and cause normal tasks, such as walking, to become uncomfortable.

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There are many treatments for vaginal dryness, ranging from homeopathic to prescription medications. Many women who are undergoing moderate vaginal dryness related to cancer treatment turn to vaginal estrogen to relieve their dryness. In this excerpt provided by UptoDate, an electronic resource used by many patients and their doctors looking for in-depth medical information, vaginal estrogen is explained:

"Vaginal estrogen is the most effective treatment option for women with vaginal dryness. Vaginal estrogen must be prescribed by a healthcare provider.

"Very low doses of vaginal estrogen can be used when it is put into the vagina to treat vaginal dryness, and little to no estrogen is absorbed into the bloodstream. As a result, there is a much lower risk of side effects, such as blood clots, breast cancer, and heart attack, compared with other estrogen-containing products (birth control pills, menopausal hormone therapy)."


Vaginal estrogen is available in a cream, suppository, tablet, and vaginal ring form. All are inserted into the vagina and must be prescribed by a physician. Some of the more commonly prescribed vaginal estrogen medications include:

  • Vagifem
  • Estrace
  • Premarin
  • Estring

When using vaginal estrogen, be sure to ask your doctor or pharmacist if condoms are safe to use with your prescribed medication. Some types of vaginal estrogen can decrease the effectiveness of condoms by weakening the latex.

In addition, with some vaginal estrogen products, you may be advised to avoid consuming grapefruits and grapefruit juice, as they may increase side effects.

Side Effects

Like with all medications, vaginal estrogen has potential side effects. The amount of estrogen in vaginal estrogen products is low, so the chance of experiencing side effects is minimal. Side effects can include, but are not limited to:

  • Breast tenderness/pain
  • Vaginal discharge
  • Upset stomach/vomiting
  • Insomnia
  • Hair loss or hair growth
  • Melasma (dark spots on the skin)
  • Hot flashes
  • Depression/anxiety/moodiness

Keep in mind that because of the low amount of estrogen in vaginal estrogen products, side effects are not very common. You should report all side effects to your doctor.

Special Information for Women With Breast Cancer

According to this excerpt provided by UptoDate:

"The safety of vaginal estrogen in women who have a past history of breast cancer is unclear. A small amount of estrogen can be absorbed from the vagina into the bloodstream. If you have a history of breast cancer, talk to your healthcare provider or your oncologist about the potential risks and benefits of vaginal estrogen."

The concern of added estrogen is for women with estrogen receptor-positive (ER+) breast cancers who are taking aromatase inhibitors to prevent recurrence. Women with ER+ breast cancer have tumors that rely on estrogen to grow. Aromatase inhibitors help prevent cancer from returning by suppressing the production of a type of estrogen.

Still, if other non-estrogen remedies are ineffective, many physicians will prescribe vaginal estrogen to women with persistent vaginal dryness because of the low amount of estrogen in the product and how little is actually absorbed.

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  1. UpToDate. Patient education: Vaginal dryness (Beyond the Basics). Updated October 24, 2018.

  2. Lindahl SH. Reviewing the options for local estrogen treatment of vaginal atrophy. Int J Womens Health. 2014;6:307–312. doi:10.2147/IJWH.S52555

  3. Pfizer, Inc. PREMARIN VAGINAL- conjugated estrogens cream.