Vaginal estrogens have always had somewhat of a “risky” reputation. Early studies painted a pretty gloomy picture on the safety of estrogen, linking its use to heart issues and cancer risks. But there were also some flaws in these studies, and newer research about vaginal estrogen breast cancer and your pelvic floor has much more reassuring safety info.
For breast cancer survivors, the question of whether vaginal estrogen is safe for managing pelvic floor symptoms has been a hot topic. Many women worry that using vaginal estrogen might bring their breast cancer back.
But recent research has shed a more positive light on the relationship between vaginal estrogen and breast cancer. It suggests that the benefits may outweigh the potential risks for many. So, could vaginal estrogen be the answer for your uncomfortable vaginal symptoms even if you had breast cancer?
How does breast cancer treatment affect the pelvic floor?
Often, those with breast cancer find themselves with a bunch of pelvic floor issues, like bladder leaks and painful sex.
Why this is happening is unclear. But it’s thought to be because of the different breast cancer treatments — like chemo and hormone (or endocrine) therapies — and the way that they impact your ovaries and estrogen levels in your body.
Estrogen and Pelvic Floor Health
Estrogen has a lot of important roles in your body, but especially in your reproductive and urinary systems. Your vaginal, bladder, and pelvic floor tissues are packed with estrogen receptors. When estrogen levels are normal your tissues are plump and healthy, have good blood flow, and plenty of natural lubrication.
But when estrogen levels are low, like they can be during during breast cancer treatment and menopause, you might end up with something called Genitourinary Syndrome of Menopause (GSM). This is a fancy name for all the not-so-fun changes that happen to your vagina and bladder when estrogen levels are low.
Low estrogen levels can cause:
- Your vagina to feel itchy or more sensitive than usual
- Increased risk of infections (like UTIs or yeast infections)
- Pain during sex (dyspareunia)
- A change in bladder function (like bladder leaks, urgency, or feeling like you always have to go)
- Pelvic floor muscle weakness
The “gold standard” fix for GSM is usually estrogen therapy (both systemic and vaginal estrogen). For most folks, it can feel like a magic wand for these frustrating and uncomfortable low-estrogen symptoms. But if you have a history of breast cancer, it can be quite scary to think about using vaginal estrogen.
Is there a link between vaginal estrogen, breast cancer and your pelvic floor?
The connection between vaginal estrogen use and breast cancer recurrence or death is still an active area of study. Right now, experts agree that there isn’t much evidence to say that vaginal estrogen is dangerous if you have a history of breast cancer.
Studies show that vaginal estrogen is pretty safe and works like a charm for symptoms of GMS in those with breast cancer. And the chances of your cancer coming back are about the same whether you use it or not.
The American College of Obstetricians and Gynecologists (ACOG) also supports vaginal estrogen use for breast cancer survivors if non-hormonal treatments aren’t cutting it for pelvic floor symptom relief.
While it is generally recognized as safe, it’s important to remember that everyone is different. So before you start using vaginal estrogen, it’s probably best to have a chat with your healthcare team, especially your oncologist. They know you and your specific health risks so they can help you make the best call for your pelvic floor health.
How to Help Your Pelvic Floor Without Vaginal Estrogen
Luckily, there are also many other ways to help improve your pelvic floor symptoms with non-hormonal treatments. Try these options below to help your vagina and bladder if you’re going through breast cancer treatment.
1. Stay well hydrated.
Staying well hydrated will help improve blood flow and moisture in your vulvar and vaginal tissues. It can also help soothe urinary urgency and frequency and bladder irritation related to dehydration.
2. Use vaginal moisturizers.
There are plenty of non-hormonal vaginal moisturizers to help improve the health of your vaginal tissues. Consider natural oils like vitamin E oil or coconut oil, Medicine Mama’s vulva balm or Good Clean Love’s Restore. There are also some great over-the-counter options like VulvaCare and Revaree hyaluronic acid suppositories.
3. Try vaginal lubricant during sex.
In addition to a daily moisturizer, add a personal lubricant to your routine during sex. They can reduce vaginal irritation or tearing during penetration. Look for lubes that are paraben-free, fragrance-free, and pH-balanced to help save your pelvic floor.
4. Improve pelvic floor muscle flexibility.
A dry and irritated vulva and vagina can also irritate your pelvic floor muscles and make them more tight. Self massage, and tools like vaginal dilators can help. Dilators look like tampons and come in different sizes, and can retrain your muscles to be more flexible again without pain. Some of our favorite dilators are by Intimate Rose.
5. Practice healthy bladder habits.
To help keep your bladder symptoms under control, there are some simple healthy bladder habits that you can incorporate into your day. These include limiting bladder irritants, avoiding “just in case” trips to the bathroom, and avoiding pushing or straining while you pee to avoid increased pressure of irritated tissues.
6. Consult with a Pelvic Floor PT.
For an assessment of your pelvic floor muscles and targeted exercises to address your sexual and urinary symptoms, it is important to see a pelvic floor physical therapist. Your PT can help you with manual therapy, vaginal dilators, and pelvic floor exercises like kegels.
At-Home Pelvic Floor Exercises for bladder issues, painful sex and more!
Don’t suffer with your uncomfortable pelvic floor symptoms after breast cancer treatment. While vaginal estrogen may be helpful for some, there are also safe, non-hormonal options that can also be a lot of help.
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References:
ACOG. (2024). Treatment of urogenital symptoms in individuals with a history of estrogen-dependent breast cancer.
Agrawal, P., et al. (2023). Safety of vaginal estrogen therapy for genitourinary syndrome of menopause in women with a history of breast cancer. Obstet and Gynecol.
American Cancer Society. (2023). Hormone therapy for breast cancer.
Angelou, K., et al. (2020). The genitourinary syndrome of menopause: An overview of the recent data. Cureus.
Bodner-Adler, B., et al. (2020). Effectiveness of hormones in postmenopausal pelvic floor dysfunction—International Urogynecological Association research and development—committee opinion. Int Urogynecol J.
Colombage, U.M., et al. (2022). Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study. Support Care Cancer.
DePolo, J. (2024). Vaginal estrogen safe for women with breast cancer. Breastcancer.org
Grady, D., et al. (1992). Hormone therapy to prevent disease and prolong life in postmenopausal women. Annals of Internal Medicine.
Kohn, G.E., et al. (2019). The history of estrogen therapy. Sex Med Rev.
Mauri, D., et al. (2020). Chemotherapy associated ovarian failure. Frontiers of Endocrinology.
McVicker, L., et. al. (2023). Vaginal estrogen therapy use and survival in females with breast cancer. JAMA Network.
Weber, M.A., et al. (2015). Local oestrogen for pelvic floor disorders: A systematic review. PLOS One.
