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Which is the safer estrogen source for vaginal atrophy and urinary tract problems, estrogen ring or vaginal estrogen cream?

By January 24, 2009 - 9:25am
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I am 57 and am in menopause. My mother had breast cancer so I was not a candidate for oral estrogen to manage menopause symptoms. I have used Effexor and vaginal estrogen cream to manage symptoms. Recently the hot flashes started subsiding and I went off of the effexor. I still require the vaginal estrogen cream to prevent urinary incontinence/vaginal atrophy. It seems like the estrogen ring would be safer for women with breast cancer risk. My doctor is willing to switch me to the estrogen ring if I can find some information on the safety. What are others experiencing with using vaginal estrogen cream or the estrogen ring?

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EmpowHER Guest

Natural progesterone in the form of hormone cream safely treats hormone imbalance from menopause. The symptoms of menopause can include depression, irritability, infertility, incontinence, endometriosis, hot flashes, vaginal dryness, osteoporosis, cardiovascular disorders, night sweats and irregular menstrual flow. Progesterone is therefore used in hormone replacement therapy for menopausal women.

October 13, 2010 - 10:34am

Hi there KDC, Thanks for your question ... We asked Dr. Philip Sarrel, one of the leading sexual health experts in the country to respond to your post. Here is his thoughtful answer.

"It’s interesting that your age is 57 as that is the particular age for which specific data about vaginal atrophy is available in several studies. Vaginal atrophy means the shrinkage of vaginal and vulva tissue and a loss of cell function. Shrinkage of the tissue narrows the vaginal opening making penetration painful. Thinning of the vaginal walls and the external genitals (the vulva) makes these tissues vulnerable to tearing and infection. The decrease in cellular function leads to dryness of the vulva and vagina.
By age 57, it is estimated that 2/3 of women experience vaginal and vulva dryness secondary to atrophy. Pain with intercourse is the most common complaint affecting about half the women who are sexually active at your age.

Vaginal atrophy due to menopause is prevented by the use of estrogen and can also be reversed in women who have not used estrogen since their menopause occurred. All types of estrogen treatment are approved for prevention and treatment of vaginal atrophy including the estrogen ring that you mention. The estrogen ring provides a very small amount of estrogen which works locally on the vaginal tissues. The ring is easy to insert and is changed for a new one every three months. The ring has been available for about 15 years. Because the estrogen ring shows a good tissue effect with a minimal amount of estrogen and the lowest blood levels of estrogen of any of the postmenopause hormone treatments, it is suggested that it is hypothetically the safest to use for women at high risk for breast cancer or even for women who have had breast cancer. However, there are no published studies of the estrogen ring vs. other treatments vs. placebo with respect to breast cancer risk.

There are between 50 and 100 major, published studies of estrogen not combined with other hormones such as progesterone and the risk of developing breast cancer. Some show increased risk while others show either no increase or a decreased risk when using just estrogen. For example, one of the studies shows that using relatively high doses of systemic (oral) estrogen for more than 15 years increased breast cancer risk. On the other hand, the most important study in the United States, the Women’s Health Initiative, did not show an increased breast cancer risk in the women who just received estrogen for seven years compared to the women who received a placebo treatment. There are many informed physicians who would tell you that it would be an option for you to take a low-dose, systemic estrogen (and I am one of them). But, you seem to have thought about this and have a preference for the estrogen ring and I certainly can support that decision."

February 3, 2009 - 2:24pm
EmpowHER Guest
Anonymous (reply to Tina Tran)

Comment by KDC -My sincere thanks to Dr. Philip Sarrel for answering my question. I had not realized that I could be a candidate for oral estrogen. Taking systemic estrogen would eliminate the vaginal atrophy and take care of the last of my menopause symptoms, insomnia. I have always taken pride in having very good sleep habits but have not been able to sleep well since going through menopause. I had resigned myself to giving up some quality of life. Thanks again.

February 9, 2009 - 8:18pm
Expert HERWriter


Thank you for coming to EmpowHer to post your question. I'm not quite sure what the answer is but, I think we should check into it for you.

I thought I'd ask Drs. Rosenman and Greep. Here's a link to some important information they've answered for women in our community. They do mention the estrogen ring in this article along with the other forms of estrogen for incontinence etc. Here's the link.. http://www.empowher.com/providers/article/menopause-101-amy-rosenman-md-and-nancy-greep-md

We actually gave these amazing doctors questions women have asked us over and over again. And they were kind enough to respond to our community of women in very easy and comprehensive way.

Let's see if we can get a response from one or both of these great doctors.

We'll be back in touch. Good for you for doing your own research and trying to sort this out. For some reason...I get the feeling the ring may be a good choice for you but I'm not a doctor and don't know if the effects are different. Just my female intuition kicking in.

Best in health,


January 24, 2009 - 8:18pm
(reply to Michelle King Robson)

Thank you for your thoughtful reply. I am waiting to see what the physicians say. I too think at an intuitive level that the estrogen ring would be a safer choice for me.
Thanks again,

January 27, 2009 - 3:30pm
EmpowHER Guest

I also come from a long line a breast cancer in the family and it happens to be a hormonal strand so I try and stay away from hormones myself. Many women suffering from vaginal atrophy find relief by using locally-applied, natural estrogen products. As opposed to oral HRT, locally-applied bioidentical estrogen can help persistent vaginal dryness without passing large amounts of estrogens throughout the rest of your system.

The Mayo Clinic provides great information on the treatment of vaginal atrophy and can be found on this link http://www.mayoclinic.com/health/vaginal-atrophy/DS00770/DSECTION=treatments%2Dand%2Ddrugs.

Any risks involved with using vaginal estrogen can be found on this link provided by the National Institute of Health http://www.nlm.nih.gov/medlineplus/druginfo/meds/a606005.html.

There is also an article from Webmd.com that indicates that breast cancer and vaginal estrogen was a little risky and that information can be found here http://www.webmd.com/breast-cancer/news/20060125/breast-cancer-topical-estrogen-risky.

Your physician knows you best and you should really try and take into consideration your risks for breast cancer. I hope this helps. Let us know how you are doing.

January 24, 2009 - 10:14am
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