If you’ve had breast cancer, hearing the word “estrogen” may immediately make you pause. “You may have been conditioned to think that you can’t ever take anything that has estrogen ever again,” Dr. Fenwa Milhouse, a urologist and certified menopause practitioner, told ThisIsMenopause. However, she said, “that is not true” in the case of vaginal estrogen.

After considering your personal circumstances with your healthcare team, you might find that vaginal estrogen is an option for treating symptoms like vaginal dryness or urinary incontinence. Here’s what to know about breast cancer and vaginal estrogen.

How Can Breast Cancer Treatment Affect the Vulva and Vagina?

Many breast cancer treatments greatly lower estrogen levels in the body or block estrogen from helping breast cancer cells grow. These effects can also contribute to genitourinary syndrome of menopause (GSM). Common GSM symptoms include:

• Vaginal dryness, burning, or irritation
• Pain during sex
• Urinary urgency or incontinence
• Recurrent urinary tract infections

“Fifty percent to 90 percent of individuals with a vulva experience GSM,” Dr. Milhouse said. GSM may develop during perimenopause, but breast cancer treatment can make the symptoms happen sooner or become more severe.

“The treatments for breast cancer often put somebody in a menopause state more severely than just natural menopause,” Dr. Milhouse said. If left untreated, these symptoms can have a great impact on quality of life.

Is Vaginal Estrogen Safe After Breast Cancer?

Vaginal estrogen is one of the most effective ways to treat GSM, but is it safe if you’ve had breast cancer?

The answer depends on individual factors, but vaginal estrogen can be a safe option for many women who’ve had breast cancer. You should work closely with your healthcare team, including your oncologist, to weigh the benefits and risks before deciding on treatment.

Does the Type of Breast Cancer You Had Matter?

The majority of breast cancers are hormone receptor-positive, meaning the cancer cells use estrogen or progesterone to grow. Raising estrogen levels throughout the body could increase the chance of hormone receptor-positive breast cancer coming back. That’s why systemic hormone therapy — such as estrogen pills, patches, and gels to treat menopausal symptoms — is usually not recommended after breast cancer.

Vaginal estrogen therapy is “different from systemic estrogen in that it’s not estrogen that is meant to increase or get taken up by the bloodstream,” Dr. Milhouse said.

Studies have found that low-dose vaginal estrogen results in very little estrogen being absorbed into the bloodstream. Instead, most of its effect is in the vaginal tissues. “The estrogen that is applied for vaginal estrogen stays in the local tissues,” Dr. Milhouse said.

For hormone receptor-negative breast cancer, in which cancer cells don’t use hormones to grow, there may be less concern about using hormonal treatments.

Does Vaginal Estrogen Raise the Risk of Breast Cancer Recurrence?

“There have been multiple studies that have looked at breast cancer survivors who were given vaginal estrogen for one or more complaints,” Dr. Milhouse said. “They’ve found that there is no increased risk of breast cancer recurrence when you give somebody vaginal estrogen.”

For example, a 2025 review of eight studies found no increase in breast cancer recurrence among postmenopausal breast cancer survivors who used low-dose vaginal estrogen. More studies are needed to better understand long-term safety in premenopausal women and with different doses of vaginal estrogen.

The research is also less certain for women taking aromatase inhibitors, a type of treatment for hormone receptor-positive breast cancer.

What Are the Alternatives to Vaginal Estrogen?

If you prefer not to use estrogen or your doctor recommends against it, other treatments that may help relieve GSM symptoms include:

• Vaginal moisturizers and lubricants
• Vaginal dehydroepiandrosterone (DHEA), a treatment made from a hormone the body naturally produces that converts to estrogen and testosterone in vaginal tissues and requires careful consideration after breast cancer
• Pelvic floor therapy, such as pelvic floor muscle (Kegel) exercises

“A lot of patients with genitourinary syndrome of menopause may also need pelvic floor physical therapy because they’ve developed pelvic floor dysfunction,” Dr. Milhouse said.

Some women may benefit from combining moisturizers, lubricants, and pelvic floor therapy. If you take vaginal estrogen, you can also use nonhormonal treatments, such as vaginal moisturizers.

Don’t Put Off Getting Help for GSM

Don’t assume you can’t use vaginal estrogen or that you have to live with vaginal dryness, painful sex, or bladder problems. Available treatments may help.

Dr. Milhouse encouraged being proactive about GSM symptoms: “Never wait for it to get bad.”