From the Guidelines
Using vaginal estrogen cream is generally not recommended for individuals with endometriosis, as it can stimulate endometriosis growth and exacerbate symptoms like pelvic pain, inflammation, and lesion growth. Estrogen can stimulate endometrial-like tissue growing outside the uterus, and even topical vaginal estrogen products can be absorbed systemically to some degree, potentially worsening endometriosis symptoms 1. If you're experiencing vaginal dryness or atrophy, consider discussing alternative treatments with your healthcare provider, such as:
- Regular moisturizers (like Replens)
- Lubricants during intercourse
- Potentially progestin-only options Some providers might consider low-dose vaginal estrogen in specific cases where benefits outweigh risks, particularly if symptoms are severe and other treatments have failed, but this requires careful monitoring and individualized assessment 1. Always consult with your gynecologist or endometriosis specialist before using any hormone-containing products, as they can evaluate your specific situation and disease severity to determine the safest approach for managing your symptoms. According to the most recent study, vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction, but its use in individuals with endometriosis is not recommended due to the potential risk of exacerbating the condition 1.
From the FDA Drug Label
- Exacerbation of endometriosis Endometriosis may be exacerbated with administration of estrogens. A few cases of malignant transformation of residual endometrial implants have been reported in women treated post-hysterectomy with estrogen alone therapy For patients known to have residual endometriosis post-hysterectomy, the addition of progestin should be considered.
Vaginal estrogen cream is not recommended for patients with endometriosis as it may exacerbate the condition 2, 2.
- Key points:
- Estrogen administration may worsen endometriosis
- Addition of progestin may be considered in some cases
- Patients with endometriosis should be cautious when using estrogen therapy.
From the Research
Vaginal Estrogen Cream and Endometriosis
- The use of vaginal estrogen cream in women with endometriosis has been studied in various research papers 3, 4, 5, 6, 7.
- A study published in 2005 compared the safety of a continuous low-dose estradiol-releasing vaginal ring to that of a vaginal estradiol tablet on the endometrium and found no statistical difference between the groups in the alleviation of symptoms and signs of urogenital estrogen deficiency 3.
- Another study published in 2019 systematically reviewed studies that evaluated endometrial hyperplasia or cancer incidence with unopposed vaginal estrogens and found that the studies did not support an increased risk of endometrial hyperplasia or cancer with low-dose vaginal estrogens 4.
- A study published in 2010 evaluated the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy and found that the results supported the endometrial safety of unopposed ultra-low-dose vaginal estrogen 5.
- A retrospective cohort study published in 2020 found that vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma did not increase the risk of adverse outcomes, including cancer recurrence, venous thromboembolism, and secondary malignancies 6.
- A review published in 2023 discussed the metabolism, receptor binding, and signaling of estrogens in vaginal and endometrial tissue and summarized the existing studies on the endometrial impact of low-dose vaginal estrogen treatment in postmenopausal women, concluding that low-dose vaginal estrogens do not substantially increase the risk of endometrial hyperplasia or cancer 7.
Key Findings
- Low-dose vaginal estrogens do not substantially increase the risk of endometrial hyperplasia or cancer 4, 5, 7.
- Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma does not increase the risk of adverse outcomes 6.
- The endometrial safety of low-dose vaginal estrogens has been supported by various studies 3, 4, 5, 7.