Vaginal Estrogen: Low Dose, High Impact
Breast Cancer Survivorship & Patient Experience
It is one thing to write about how vaginal estrogen can be safe and highly effective in improving our quality of life. It is another thing to actually experience it.
Vaginal estrogen has been transformational.
I had no idea that a low dose of vaginal estrogen could improve my quality of life so much. I wish I had asked for it sooner.
Important Note: I’m not a doctor, so please discuss all treatment options with your medical team. See this page for more information.
Early Symptoms- Side Effects of Tamoxifen
I first began experiencing serious issues with vaginal dryness and irritation when I was on tamoxifen. Lubricant became a must-use. In addition, I was experiencing itching and burning symptoms. I thought that I had an Urinary Tract Infection. But, after running tests, it was not an infection; it was a symptom of the reduced estrogen in the tissues of the vagina.
The official term for the variety of symptoms I was experiencing is Genitourinary Syndrome of Menopause (GSM). In my case, it was brought on by the tamoxifen.
Everything was dry, sensitive, and angry.
I remember bringing my symptoms up to both my oncologist and my gynecologist in 2020. They offered me various options to address them. First-line treatments were non-hormonal and included lubricants and vaginal moisturizers. If those didn’t help, we could move on to vaginal estrogen.
I found a lubricant that was gentle enough for my skin, and for years, that has been enough. Here’s the one I like, made by Lola (Affiliate Link and my Disclosures): Find on Amazon
Under the care of my oncologist, I ended up stopping tamoxifen in late 2020 for another side effect ( you can read about it here). I noticed my vaginal symptoms improved- especially the issue with the dry and burning skin on the exterior of my vulva. The lubricant was still essential, but I didn’t need to use anything else.
Current Symptoms- Perimenopause Changes I Could No Longer Ignore
In late 2023, I began noticing that things were changing again. I was experiencing increased Stress Urinary Incontinence when I sneezed. One sneeze was manageable. But often, I had sneezing fits of 15 or more sneezes in a row. Not only was I embarrassed because I was sneezing so much… but I was also leaking urine with every sneeze.
That was “super fun.”
In addition to the stress urinary incontinence, I was also experiencing severe vaginal dryness. The lubricant wasn’t helping. My tissues were thinning, and things weren’t pleasant for me or my husband.
Then, the exterior skin of my vulva began to thin. Everything was extremely sensitive. I often found myself mentally debating if the pleasure I wanted during intimacy was worth the irritation to my already sensitive vulva region. These were all symptoms that my GSM was getting worse.
Something needed to change— because I wasn’t ready to say goodbye to intimacy.
I began using some of the non-hormonal vaginal moisturizers, and for a while, they helped a bit. But then, it started feeling like I was allergic to the moisturizer ingredients. So, I stopped using them, and things got worse.
Asking My Primary Care Doctor for a Prescription
Unfortunately, I was between gynecologists when these symptoms escalated. But I had a physical scheduled (with a new doctor), and I decided I needed to have the conversation.
Since I was seeing a new primary care doctor, I didn’t know what her perspective would be on prescribing vaginal estrogen for breast cancer survivors would be. So I came armed to the appointment with the notes from my oncologist, stating his support for that line of treatment, and also new research reports indicating that low-dose vaginal estrogen is safe for breast cancer survivors. (I’ll include links at the bottom of this post).
I was ready to advocate!
It turns out my research and notes weren’t necessary. She was happy to prescribe me the vaginal estrogen cream. She wanted me to use a low dose and follow up with my new gynecologist at my appointment in a few months.
So, What is it Like to Use it?
Once I filled my prescription, I was ready to try the cream. Unlike the over-the-counter moisturizers I’d tried, I was pleasantly surprised that my insurance covered the medication.
There are a few different ways to prescribe vaginal estrogen: Creams, rings, suppositories, and tablets. I was prescribed the cream.
My doctor prescribed an initial dosage of .5g daily for two weeks, which was then reduced to twice a week. This is a very low dose, and after I saw how little cream I’d be using, I wondered if it would be effective.
Included with my cream was an applicator that screws onto the cap of the cream, enabling me to be precise with my dosage.
Inserting the cream was pretty straightforward. The applicator looked like a tampon and was pretty easy to use. Since I was going to bed right after application, most of it stayed inside my vagina and didn’t leak out.
As far as the timing of the vaginal estrogen and sex— I use the cream after. Sometimes, this results in more leakage of the cream onto my underwear, but it’s worth it!
I don’t use the cream during my period, but I make sure to get right back into using it after my cycle. I have found that my vaginal dryness is the worst just after my period finishes, so resuming my usual dosage is key once my cycle is done.
One thing I don’t enjoy about the applicator is that it is a pain to clean. The cream seems to get stuck in the threads of the applicator, and I need to spend more time than I want before bed to get it nice and clean. I have a routine down now, but that is my least favorite part about using the vaginal estrogen cream.
Low Dose- High Impact: My Personal Experiences After a Few Months
I had pretty low expectations that vaginal estrogen would make a difference. I’d read the research, followed other doctors on social media who discussed its benefits, and talked to fellow breast cancer survivors about their experiences, but still, I was approaching this as a “last resort.” Nothing else was working, and I felt like I was hitting a crossroads. Something needed to change!
After only a few uses, I felt the impact. My vagina felt like it was rejuvenated. The skin around my vulva wasn’t irritated. Even my husband commented that things were feeling amazing for him. And my orgasms were more enjoyable. It turns out that lovemaking is more fun when it doesn’t hurt…
Vaginal estrogen has been a game-changer for me. Everything (yes, everything) feels better! When I used the OTC solutions, the improvement was short-term and felt relatively superficial. Vaginal Estrogen is working differently. It feels as if my tissues are healing.
I am also experiencing reduced stress urinary incontinence. It hasn’t disappeared, but it is improving. When I went to see a specialist, she couldn’t see me leaking during the examination.
I am shocked at the impact that low-dose vaginal estrogen has made on my life in such a short time. It is amazing.
Self-Advocacy Encouragements and Resources
It was hard for me to get to the point where I decided to ask for the prescription. And I talk about personal things and self-advocacy all the time.
I went into my primary care appointment with links to the latest research regarding vaginal estrogen and breast cancer survivors. This helped me feel more comfortable as I brought it up. I didn’t need to show the doctor the links, but I was prepared. I also found the medical notes from my oncologist stating his support for the treatment.
But I was still anxious. So, if you’re feeling that way, too, you’re not alone!
Advocating for ourselves, especially in areas of our sexuality, can be a challenge. However, things won’t get better if we don’t address our issues.
Here is one of the biggest takeaways from my research into my GSM symptoms: If they are not addressed, they will get worse, not better.
I’m thankful that such a low dose of vaginal estrogen has had such a high impact on my life. And now, I have a date with my husband to plan….
Resources:
- BreastCancer.org: Vaginal Estrogen Safe for Women with Breast Cancer
- Journal of American Medical Association (JAMA): Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer
- What is GSM (genitourinary syndrome of menopause):
- NCI Article on GSM: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
- BreastCancer.Org Article: https://www.breastcancer.org/treatment-side-effects/vaginal-dryness/atrophy-GSM
- Dr. Eleonora Teplinsky: Oncologist. Follow on Instagram @drteplinsky Excellent reel discusses perspective on low-dose vaginal estrogen for breast cancer survivors : View on IG
- Dr. Ashley G. Winter: Urologist, Sex Med Doctor, and Vaginal Estrogen advocate. Follow on X: @AshleyGWinter. See this video on the benefits of vaginal estrogen on Urology Times
Jennifer Douglas
Jennifer is the author of "A Breast Cancer Journey: Living it One Step at a Time," breast cancer survivor, and patient advocate. Her book, published in 2023 by Bold Story Press, is an encouraging guide for breast cancer patients. It contains first-hand information, organized by topics, to help readers navigate the diagnosis, treatment, and recovery from breast cancer. Her writing emphasizes emotional, mental, and physical well-being along with empowered decision-making.
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