One of the most common, but least discussed symptoms of peri/menopause is vaginal dryness (and the painful sex and urinary symptoms that often accompany it). These issues are part of something called genitourinary syndrome of menopause (GSM) that happens as oestrogen levels decrease.
It's a tricky topic for any woman, but even more so for women who have a history of breast cancer.
So what does the evidence say for vaginal oestrogen (cream and/or oestrogen tablets inserted vaginally) in women with a breast cancer history?
Research consistently shows that vaginal oestrogen is safe for women with a history of breast cancer:
- A large study of 49,237 women with breast cancer found that those using vaginal oestrogen after diagnosis did not have a higher risk of dying from breast cancer. In fact, their risk was slightly lower than women who did not use it (adjusted HR 0.77, 95% CI 0.63–0.94) [1].
- Another analysis of over 24,000 breast cancer survivors found no increased risk of the cancer coming back, and no higher risk of death from breast cancer or overall causes, among women using vaginal oestrogen [2].
- A large U.S. study found that using vaginal estrogen for menopause-related vaginal symptoms did not increase the chance of breast cancer coming back in women who had previously had breast cancer [3].
Dr Louise Newson weighs in on this topic a lot and explains that vaginal oestrogen is very different from systemic HRT:
- It is applied locally, directly where it is needed.
- It is very low dose, so almost none is absorbed into the bloodstream.
- This makes it usually safe even for women who have had breast cancer [4].
Medical guidelines from ACOG and NICE support this approach. They suggest that after trying non-hormonal treatments like moisturisers, low-dose vaginal oestrogen can be considered for women with a breast cancer history—but decisions should always be made together with an oncologist, weighing benefits and any risks [4].
In summary: while systemic oestrogen (what we often just call HRT) is sometimes avoided after breast cancer, vaginal oestrogen offers a safe and effective way to manage GSM symptoms for many women.
References
- McVicker KL, Coupland VH, Hughes RA, et al. Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer. JAMA (2024).
- Beste ME et al. Am J Obstet Gynecol. 2025 Mar;232(3):262-270.e1.
- Agrawal P, et al. Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. 2023. Large U.S. claims-based study; vaginal oestrogen use was not associated with increased breast cancer recurrence.
- Newson L. A guide to menopause if you’ve had breast cancer. Vaginal hormones (local hormones) are very low dose and do not get absorbed into your body; can safely be prescribed for women who have had any type of breast cancer.
