Should you consider topical estrogen?
We know that hormone supplementation in the past has had a bad reputation, but we are ready to re-examine the current research and trends regarding topical estrogen. Estrogen levels in the body can fluctuate, both as part of the normal menstrual cycle (spiking right before ovulation, then going through a steady rise before flow starts), and in other life stages including menopause and during postpartum when nursing.
Let’s talk about menopause and perimenopause. Menopause is the stage of life once menstrual periods have stopped, but there can be a wide range of ways to get there, and sometimes that includes a lengthy period of perimenopause, where periods are irregular but still happening. The age range of starting perimenopause is vast - anywhere from around 40-60 years old.
Estrogen levels are declining in perimenopause and stay low in menopause. Decreased estrogen can create problems that fall under the catch-all diagnosis of Genitourinary Syndrome of Menopause (GSM). GSM can include symptoms like increased vaginal dryness, burning and irritation of vaginal tissue, low lubrication and painful sex, urinary frequency, urgency of urination, and increased vulnerability to urinary tract infections. Because these are physical changes in response to estrogen changes, adding local estrogen makes sense as a treatment option for some.
But is it safe? Recent studies suggest so. The NIH published an observational study of women using local estrogen and their findings indicate that “the risks of cardiovascular disease and cancer were not elevated among postmenopausal women using vaginal estrogens, providing reassurance about the safety of treatment.” Does this include women who have had prior diagnoses of cancer, or is there still a risk?? The International Journal Of Gynecological Cancers looked at women with prior diagnoses of uterine, cervical, or ovarian carcinoma found adverse outcomes infrequent and concluded that vaginal estrogen may be considered safe for gynecologic cancer survivors.
If you decide supplementation may be for you, the first step would be to coordinate with your doctor, since there are a range of types of application. Local estrogen can be prescribed as topical creams, intravaginal tablets, or rings that can be inserted and changed every three months, for example. Results may take a month or two to determine full effect, and may be used for long periods.
Topical estrogen can be part of your care plan, in conjunction with your PT or acupuncture care. As care providers, we know local estrogen can be beneficial, but it may not be the only answer. Understanding you as a person is key in addition to any hormonal intervention. We want to support your overall system - that may mean supportive exercises, dietary, or lifestyle suggestions, alongside medication.