Estradiol for vaginal atrophy after breast cancer. Is it safe?

Posted by tres77 @tres77, Mar 10, 2024

I have developed severe atrophy 25 years after estrogen receptive breast cancer. Did chemo, radiation and 5 years of Tamoxifen. I was always told NO estrogen. I am experiencing extreme pain and bleeding so sexual intimacy is impossible. I also have been diagnosed with Lichen sclerosus. I am 65 years old. My gyno has prescribed Estradiol vaginal cream 0.01%. I am told the new view and trials say is it is safe for breast cancer survivors. Anyone been down this route or had their gynecologist say this? I really want to try this for quality of life with my husband but I am also very scared.

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Profile picture for denverchick @denverchick

Kensiejames: I am just looking at your March 2024 comment in July 2025. Your specifics are SO HELPFUL. And relieving. I am 3 years after estrogen receptor+ breast cancer/chemo/radiation and am on Letrozole. (And I'm in my late '70's.) I read about estrogen cream for the vaginal dryness that keeps me from intercourse with my husband, and queried my oncologist via my electronic chart. She didn't reply personally, her RN did. She said they thought it was safe and offered to phone in a prescription for me. That's it. There are some women's doctors who are good at their specialty but really don't know how it feels to have cancer, and don't appreciate how much we REALLY DON'T WANT TO HAVE IT AGAIN. So anything that has "estrogen" in the name that we're thinking of trying feels scary unless we have reassurance from a professional that it really is safe. So--thank goodness for this site, and a breast cancer site on Reddit for helping us all have more peace of mind. Thank you, Kensiejames.

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Hey there! I am just now seeing your post to me. I have to get better at checking in with this site. My humble opinion, the blood test to check your estrogen levels is very telling. My number is well below my oncologist expectations.
Recently, my PCP spoke out against my using estrogen creams. I understand his concern. Estrogen cream does get absorbed into your body. When I first started using, GYN had me at 1 gram a week, and my blood work showed estrogen level was above the norm for my age group . Scary for a breast cancer survivor.
So it does get absorbed into the bloodstream . For me, 1/2 gram every two weeks was just enough to solve my problem and keep estrogen levels in the negative numbers.
I am 20 years out now, and God willing I will remain in remission. 🙏🏻

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Profile picture for kensiejames @kensiejames

Hey there! I am just now seeing your post to me. I have to get better at checking in with this site. My humble opinion, the blood test to check your estrogen levels is very telling. My number is well below my oncologist expectations.
Recently, my PCP spoke out against my using estrogen creams. I understand his concern. Estrogen cream does get absorbed into your body. When I first started using, GYN had me at 1 gram a week, and my blood work showed estrogen level was above the norm for my age group . Scary for a breast cancer survivor.
So it does get absorbed into the bloodstream . For me, 1/2 gram every two weeks was just enough to solve my problem and keep estrogen levels in the negative numbers.
I am 20 years out now, and God willing I will remain in remission. 🙏🏻

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Kensiejames:
This is such an informed and helpful reply. Thanks so much.

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Profile picture for denverchick @denverchick

Kensiejames: I am just looking at your March 2024 comment in July 2025. Your specifics are SO HELPFUL. And relieving. I am 3 years after estrogen receptor+ breast cancer/chemo/radiation and am on Letrozole. (And I'm in my late '70's.) I read about estrogen cream for the vaginal dryness that keeps me from intercourse with my husband, and queried my oncologist via my electronic chart. She didn't reply personally, her RN did. She said they thought it was safe and offered to phone in a prescription for me. That's it. There are some women's doctors who are good at their specialty but really don't know how it feels to have cancer, and don't appreciate how much we REALLY DON'T WANT TO HAVE IT AGAIN. So anything that has "estrogen" in the name that we're thinking of trying feels scary unless we have reassurance from a professional that it really is safe. So--thank goodness for this site, and a breast cancer site on Reddit for helping us all have more peace of mind. Thank you, Kensiejames.

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Call me chicken, but as my oncologist says, DO NOT use anything with estrogen in it, so I don't. I use Replens and it works really well for me. No estrogen in it.

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Eleanorrigby:
OK, thank you. I tried Replens a while after the chemo, and I was so dry that getting the applicator in was painful. It has been a couple of years since then, but maybe I should work a little harder at it. Again, thanks for your perspective.

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Profile picture for denverchick @denverchick

Eleanorrigby:
OK, thank you. I tried Replens a while after the chemo, and I was so dry that getting the applicator in was painful. It has been a couple of years since then, but maybe I should work a little harder at it. Again, thanks for your perspective.

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I get the one where there are individual applicators for each use. So 6 in a box. You could actually squeeze just a little bit out of the applicator and spread it around the thip and further to make it slide right in. I tell the oncologist that the worst of anastrazole is the vajayjay - swollen, inflamed, sore, painful. But this Replens has worked great for me over the last two years! Hope you can make it work for you.

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Profile picture for eleanorrigby @eleanorrigby

I get the one where there are individual applicators for each use. So 6 in a box. You could actually squeeze just a little bit out of the applicator and spread it around the thip and further to make it slide right in. I tell the oncologist that the worst of anastrazole is the vajayjay - swollen, inflamed, sore, painful. But this Replens has worked great for me over the last two years! Hope you can make it work for you.

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*tip,not thip

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I understand your concern using Estradiol vaginal cream. My medical oncologist (Scottsdale Mayo) said I could use this as well- a low dose. I started a 6 month chemo treatment in August so I’m still early in the process of entire treatment plan (mastectomy, radiation next). I’ll be curious about responses. Good to know Replens works for some people. I’ve also heard that Bonafide Revaree (hyaluronic acid, suppositories) are effective for some. What a journey!

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Profile picture for wews @wews

I am on letrozole and noticed vaginal dryness as well. My wonderful gynecologist recommended Bonifide reveree. She gave me a code to use to reduce cost. Every three days it is used internally and has no estrogen so my oncologist approved. It has worked wonders. I highly recommend it. A friend who is a gynocologist said she recommends any women over 50 use it. Hope this helps. My gynecologist and survivorship nurse practitioner also said using estrogen cream internally will not impact cancer issues and is another option if I want to use it.

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My breast surgeon said the vaginal estrogen is safe because it's method of estrogen delivery is different than HRT. I have read several articles stating the same. Supposedly, the "black box" warning is over 20 years old and the study back then was very small, and now they are saying the study is outdated, inaccurate, and are trying to have it removed. My oncologist and radiologist both say no. Geez!

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Profile picture for janland @janland

My breast surgeon said the vaginal estrogen is safe because it's method of estrogen delivery is different than HRT. I have read several articles stating the same. Supposedly, the "black box" warning is over 20 years old and the study back then was very small, and now they are saying the study is outdated, inaccurate, and are trying to have it removed. My oncologist and radiologist both say no. Geez!

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Huh. Mine said no problem for me to use it if needed but the bonifide reveree works great and no estrogen to be concerned about!

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Right now the tamoxifen has reversed my vaginal atrophy. I’m post menopausal so tamoxifen is acting as an agonist for estrogen in areas of the body, but not the breast.
But, when I go off tamoxifen I’m sure I’ll revert to really bad atrophy. I’m 71, and at 60 before this all started, my genital area was awful like a 100 year old woman (sorry, no offense meant to any 100 year old reading this!).
My plan is to use Bonafide Revaree as often as recommended, and a pea size amount of estradiol cream on the vaginal opening and clitoris 2x week.
I tried a couple of the vaginal tablet inserts (Vagifem, Yuvafem) in my 60s. They did not do anything for the vaginal opening (where the skin is thin and needs to absorb a lot of friction) and my clitoris was a sad soft nothing, I believe the tablet did not drip far enough down the canal to effectly help this area.
By age 65 I was putting quite a bit of estradiol cream .01% on the areas mentioned above - and it worked great (about a tablespoon!)!
At 68, I was diagnosed with ER+ 100%, PR+ 95%, DCIS. Sigh.

I think a tiny bit of estradiol may be safe. I trust the research that says so - but much of the research on women and estrogen is all over the place with the type of estrogen and how much. I haven’t read through the research they’re using now. So I’ll trust that the estradiol is safe . . . in small doses.
And hydraulic acid, bonafide revaree, should keep the entire genital area, inside and out, from drying out.
Hope I didn’t offend anyone with my explicit explanation.

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