Dr. Angel Marie Johnson, who is the director of our Women's Health Centers, will sometimes prescribe topical vaginal estrogen cream for the following indications, many of which are associated with menopause:

• Vaginal atrophy (thinning of the vaginal walls)
• Recurring urinary tract infections (UTIs)
• Vaginal dryness (as well as itching and burning)
  
  

How does vaginal estrogen help?

Vaginal estrogen increases moisture in the vagina. It also recruits healthy blood supplies to the area, and it increases cell growth. This combination helps foster an overall healthier vagina, which also promotes the growth of healthy bacteria called probiotic, or lactobacilli.

Once you have a healthy vaginal community, it will also allow for a healthy bladder community, and can even help improve a patient's bowel function.

Is vaginal estrogen safe?

The key to remember here is that this is topical vaginal estrogen, which is simply a cream that you use in the vagina.

Inevitably, patients are wary of the cream because of the word "estrogen." They worry about their breast health and their cardiac health due to information they've read or media reports. But what they're really thinking about is hormone replacement therapies (HRT) that use estrogen as well as the results from the famous Women's Health Initiative study published in 2002 that raised questions regarding estrogen's safety. But here's the thing you need to keep in mind: in hormone replacement therapy, estrogen is delivered orally—meaning, in pill form.

Pills and creams are very different. Their absorption in the body is different. Medications that you take by mouth get processed in your abdomen and usually in your liver and by your kidneys, and then the rest of your body "sees" it. If you take an estrogen pill, your breast tissue would see it, your heart sees it, your bones see it, and, eventually, every other tissue sees it. But if you use a local cream, just in the vagina, it's only absorbed where it's applied.

So, yes—it's safe to give supplemental estrogen straight to the vagina. It does not put patients at an increased risk for breast cancer. It does not put them at increased cardiac risk. Like any medication, however, a patient can experience side effects.

What about patients who've had breast cancer?

Again, topical vaginal estrogen is safe for breast cancer patients to use. However, Dr. Johnson will contact the patient's oncologist and make sure that the oncologist also agrees that the topical estrogen cream is safe before she recommends the treatment to the patient. Dr. Johnson advocates a collaborative team approach when caring for her patients.

Bottom line: topical vaginal estrogen cream is safe when used under a doctor's supervision and for the indications specified.

Learn more about our Women's Health Centers. Or go here to schedule an appointment with Dr. Johnson.

As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

[Editor's note: This article was reviewed and updated on 5/18/21 with additional links.]