Topical Estrogen Cream

Topical estrogen cream - that’s just for menopause, right? NOPE!

A commonly prescribed medication for menopausal/post-menopausal women is a topical estrogen cream. This is a form of estrogen that is just like it sounds, estrogen compounded in a cream form that is applied to the vagina to combat the effects of loss of estrogen that occurs with post-menopausal women. It can be an extremely helpful tool in the toolbox for women after menopause. If you want a review of what estrogen is and what it does for us, check out our previous blog The Role of Estrogen: Getting to Know our Hormones.

• The cluster of symptoms that can occur for women in menopause due to lack of estrogen in the vulvar tissue can include:

• Vaginal dryness, burning, or discharge

• Genital itching

• Burning or urgency with urination

• Frequent urination

• Recurrent urinary tract infections (UTIs)

• Urinary incontinence (leakage)

• Light bleeding after intercourse

• Discomfort/pain or decreased lubrication during intercourse

• Shortening and tightening of the vaginal canal

Not all of the symptoms of the list above need to be present for a menopausal woman to be diagnosed with Genitourinary syndrome of menopause (GSM). Even just experiencing one or two of the symptoms above may indicate that you would benefit from a prescription.

Now comes the next surprise - even women in their 20’s can sometimes benefit from a prescription for topical estrogen! WHAT?! Yes, there are plenty of younger women who are dealing with many of the same symptoms listed above, and often can benefit from the addition of localized low dose estrogen being applied to the vulvar/vaginal tissues. A topical estrogen cream is a prescription medication and beyond the scope of a pelvic floor physical therapist’s practice. Medications/creams such as these require a physician prescription. Often a urologist, urogynecologist, or OB/gyn would be the provider prescribing these medications.

There are a number of situations where younger women may benefit from topical estrogen including:

• Peri-menopause (period of up to 10 years before menstruation ends when hormones are rapidly changing)

• Postpartum (estrogen drops way down after delivery of baby)

• Breastfeeding (estrogen remains suppressed with lactation)

• After surgical removal of the ovaries

• Taking medications such as birth control (even though blood levels of estrogen may be present, vulvar tissue may be estrogen-deficient)

• After chemotherapy, pelvic radiation, or as a side effect to breast cancer hormone treatments

If you are not anywhere near menopause, but you have been bothered by some of the symptoms listed above as symptoms of GSM, you may still be experiencing localized loss of estrogen of the vulvar tissue.

Maybe you are noticing that your itchiness, burning, dryness, urinary symptoms, or heaviness symptoms are worse right around the time that you are getting your period. During the menstrual cycle, while women are having their period is the time when estrogen drops to its lowest during the monthly cycle. If your vulvar tissues are already somewhat estrogen deficient, when bloodstream levels of estrogen further decrease you may experience a flare-up of your symptoms.

Women have often been fearful of using topical estrogen creams due to warning labels that include very serious side effects. Every estrogen product contains warning labels about the possibility of causing cardiovascular disorders (stroke, pulmonary embolism, deep vein thrombosis (DVT), myocardial infarction (heart attack), endometrial cancer, breast cancer, and dementia. YIKES! However, this warning label was based on old research with higher dose exposure to the bloodstream via hormonal therapy treatments. Many research studies and physicians have been working in recent years to have the warning label removed altogether from low dose estrogen creams because it is simply not a significant risk factor at the doses being prescribed, and being applied locally to the vulvovaginal tissues rather than being administered through the whole body via oral pills. Individual circumstances and family history may contribute to whether or not it is recommended for you, so working with your physician to discuss it for your symptoms is important.

I think it is also important to note that it takes consistent use of the topical estrogen for up to three months for changes in symptoms to occur. Some women experience relief of symptoms much sooner (within 1-2 weeks of use), but it should not be considered a “failed treatment” unless the cream has been used consistently for at least 8-12 weeks.

If you are experiencing any of the uncomfortable symptoms we have talked about in this blog post, reach out to your local pelvic floor physical therapist. They can assist you in treating many of the symptoms and if you may benefit from a prescription they can help you determine the right steps for your care. If topical estrogen is prescribed by your physician, you can continue to improve your symptoms with pelvic floor physical therapy while you receive individualized care to address your symptoms. Just remember, even if you are not close to menopause, you may still be a candidate for localized estrogen to be applied where you need it most!

Written by: Renee Hancock, Pelvic Floor Physical Therapist