By the way, doctor: Is vaginal estrogen safe?
Q. My doctor prescribed a low-dose vaginal estrogen cream, applied twice a week, for atrophic vaginitis. I've heard this dose is so low that it carries no health risk. Do you agree?
A. Vaginal estrogen is a very effective treatment for atrophic vaginitis, a condition that's common in postmenopausal women and results from a drop in estrogen levels. Estrogen loss can lead to thinning (atrophy) of the cells lining the vagina and urethra. As a result, women may develop vaginal dryness, itching, and pain with intercourse, as well as a high risk of urinary and vaginal infections.
Estrogens in any form — oral, transdermal, or vaginal — can help restore mucosal cells and alleviate atrophic vaginitis. But applying estrogen directly to the vagina has several advantages. The overall dose can be lower, and circulating blood levels of the hormone aren't raised significantly, so breast and endometrial tissues are less exposed. Circulating estrogen can stimulate the growth of ductal cells in the breast and endometrial cells in the uterus, increasing the risk of breast cancer and endometrial cancer.