There is another hormonal therapy besides estrogen for vaginal atrophy - dehydroepiandrosterone (DHEA). My general practitioner said it might be an option I want to try instead of estradiol if I end up needing something.

Up until now, tamoxifen has actually provided an estrogenic response in my vaginal area and reversed the severe atrophy I had prior to taking it. My body just happens to be one that tamoxifen acts as an agonist in other parts of my body besides my breasts. I’m am 18 years post menopause, and I think that has a lot to do with it.

I did use a low dose topical estradiol before being diagnosed with DCIS. I found the cream that is inserted with an applicator into the vagina as too messy, and the tablet version inserted into the vagina did not provide the estrogen where I needed it most (to help the skin at the opening be stretchy enough, and thicken the skin a bit, and on the clitoris) Sorry for explaining so graphically, at least hope it’s helpful. The best solution was a very small amount of cream applied directly on the skin that needed it the most. It is a lot less than the amount inserted with an applicator- so surely less estrogen is being absorbed.