I also had to stop using estradiol when I got ER+ breast cancer. My doctor recommended using a cream with hyaluronic acid when the moisturizers and lubricants were not helpful.
When I started Tamoxifen I got a surprise. Hormone therapies can reduce estrogen so low that makes vaginal atrophy worse. But for me, 18 years postmenopausal, Tamoxifen is acting as an agonist in body parts other than my breasts. That means it promotes an estrogenic like response - so my vaginal atrophy is gone. It’s a little unnerving and it makes me worry - but evidently it is an expected response for someone like me who had really low estrogen levels before starting hormone therapy.
It also makes me wonder if the estradiol that I was using on a regular basis prior to BC diagnosis really was part of the reason the cancer started growing when it did.

One thing I wanted to mention, since we’re on this topic 🙂
Warning, warning, graphic topic following!!
Would it make any sense that part of the problem with vaginal atrophy and sex is that the clitoris goes limp? Do you also have that problem? That the clitoris won’t/can’t get aroused? It’s not just that the vaginal skin is thin and dry.
Would increasing the blood flow to the clitoris make a difference? For men, if they have sexual dysfunction, they are more likely to get a little blue pill that is a type of vasodilator and allows more blood flow to the penis. Increasing testosterone alone does not fix the problem.
So we’re looking at female issues and only thinking that estrogen is the answer? (Besides just masking the problem with lubricants). Low estrogen is definitely driving the loss of skin quality and moisture. But maybe a little extra blood flow to the area would not only improve the skin but also help the clitoris to stiffen and become aroused. If they can manufacture a little blue pill for men, maybe they should look into creating the same function for women.
I know there is supposed to be a female viagra but “both available drugs boost the activity of chemical messengers in your brain, called neurotransmitters, that are key to helping you feel aroused.” (Cleveland Clinic)
But vaginal atrophy is not a problem that can be solved in my head. I’d like to see them really find a solution to boosting blood flow to the clitoris. Maybe that along with moisturizers, hyaluronic acid, and lubricants will bring sex back again.