From the Guidelines
Topical estrogen/progesterone cream should be applied directly to the vaginal area as directed by your healthcare provider, with vaginal estrogen creams inserted into the vagina using the applicator provided, typically at bedtime, and progesterone creams applied to areas of thin skin such as the inner wrists, inner arms, neck, or chest, rotating application sites to prevent skin irritation. The application of these creams is supported by recent guidelines, including the NCCN guidelines for survivorship, version 2.2024 1, which emphasize the importance of addressing vaginal dryness and sexual dysfunction in survivors of cancer.
Key Considerations for Application
- For vaginal estrogen creams, the typical dose is 0.5-1g of cream inserted 1-3 times weekly.
- For progesterone creams, the typical dose is 20-40mg daily (about 1/4 to 1/2 teaspoon) during appropriate times in your cycle.
- It is essential to wash your hands before and after application to maintain hygiene and prevent potential infections.
- These hormonal creams help address symptoms like vaginal dryness, irritation, and thinning tissues by delivering hormones directly to affected tissues or through skin absorption into the bloodstream, providing relief with minimal systemic absorption compared to oral medications.
Evidence Supporting the Use of Topical Estrogen/Progesterone Creams
- A study in 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy found that intravaginal testosterone cream or an estradiol-releasing vaginal ring were safe and improved vaginal atrophy and sexual function 1.
- The NCCN guidelines also discuss the use of vaginal androgens (e.g., DHEA) for vaginal dryness or pain with sexual activity, noting that while there is evidence for their effectiveness, safety data in survivors of hormonally mediated cancers are limited 1.
- The guidelines further emphasize the importance of considering the individual's history of cancer and treatment when deciding on the use of hormonal therapies, highlighting the need for a personalized approach to managing sexual dysfunction in cancer survivors 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Application of Topical Estrogen/Progesterone Cream
The provided studies do not directly address where to apply topical estrogen/progesterone cream. However, they discuss various aspects of hormone therapy for menopausal symptoms, including different types of estrogens and progestogens, routes of administration, and their effects on the body.
Routes of Administration
- The studies mention oral and transdermal routes of administration for hormone therapy 2, 3.
- Transdermal administration is noted to avoid the hepatic first-pass metabolism that occurs with oral administration, potentially reducing side effects 2.
Effects of Different Estrogens and Progestogens
- Comparisons between different estrogens (like estradiol and conjugated equine estrogens) and progestogens (like progesterone and synthetic progestins) are discussed in terms of their effects on endometrial outcomes, venous thromboembolism, cardiovascular outcomes, breast outcomes, cognition, and bone outcomes 4.
- Estradiol and progesterone may have a better safety profile compared to other estrogens and progestins in some aspects, such as venous thromboembolism and cardiovascular outcomes 4.
Application Areas for Topical Creams
While the studies do not specify where to apply topical estrogen/progesterone cream, topical creams are generally applied directly to the skin in areas where they can be most effective for the intended purpose. For menopausal symptoms such as vulvar and vaginal atrophy, topical application directly to these areas may be appropriate. However, without direct evidence from the provided studies, the most effective and safe application areas for topical estrogen/progesterone cream cannot be determined.