Is it safe to use estrogen cream during pregnancy?

Estrogen Cream Should Not Be Used During Pregnancy

Estrogen cream is contraindicated during pregnancy and should be avoided. 1

FDA Labeling: Clear Contraindication

The FDA drug label for estradiol vaginal cream explicitly lists pregnancy as a contraindication. 1 The label states: "Estradiol vaginal cream USP 0.01% should not be used during pregnancy" and lists "known or suspected pregnancy" among absolute contraindications. 1

Rationale for Avoiding Estrogen During Pregnancy

Lack of Safety Data

• While inadvertent early exposure to oral contraceptive pills (which contain estrogen) appears to have little or no increased risk of birth defects, this does not establish safety for intentional therapeutic use throughout pregnancy. 2
• The FDA label notes that estrogen should not be used during pregnancy, though it acknowledges that inadvertent contraceptive exposure early in pregnancy has not shown increased congenital anomaly risk. 1

Thrombotic Risk Concerns

• Pregnancy itself creates a hypercoagulable state that increases thrombosis risk in women with rheumatic and musculoskeletal diseases. 2
• Estrogen-containing contraceptives should be avoided during pregnancy due to possible risks, particularly in later stages of pregnancy. 2
• The CDC recommends deferring estrogen-containing contraceptive methods until at least 3-6 weeks postpartum due to venous thromboembolism risk. 2

Historical Context

• Diethylstilbestrol (a synthetic estrogen) was used to prevent miscarriage between 1938-1971 but was discontinued after clear cell adenocarcinoma of the vagina and cervix was found in exposed daughters. 3

Clinical Pitfalls to Avoid

Do not confuse inadvertent early contraceptive exposure with therapeutic indication. The evidence showing minimal risk from accidental oral contraceptive exposure in early pregnancy 2 does not justify intentional estrogen cream use throughout pregnancy. 1

Recognize that pregnancy-related conditions may mimic indications for estrogen therapy. Normal pregnancy symptoms like vaginal changes do not warrant estrogen treatment, as pregnancy already provides high endogenous estrogen levels. 2

Postpartum Considerations

• Estrogen cream should not be used during lactation, as estrogen decreases breast milk quantity and quality. 1
• Estrogen-containing contraceptives may be safely initiated 6-8 weeks postpartum to avoid impacting milk production. 2
• For postpartum lactation suppression (when desired), estrogen has historically been used but is associated with rebound lactation and increased thromboembolic disease risk. 4