Vaginal Estrogen Therapy in Bladder Cancer Survivors
Introduction to Vaginal Estrogen Therapy
- The American College of Obstetricians and Gynecologists recommends vaginal estrogen therapy for postmenopausal women with vaginal atrophy, as bladder cancer is not a hormone-dependent malignancy and does not represent a contraindication to vaginal estrogen therapy 1, 2
Treatment Options
- Vaginal moisturizers applied 3-5 times weekly to the vagina, vaginal opening, and external vulvar folds can be used as a non-hormonal option for 4-6 weeks 1, 2
- Water-based or silicone-based lubricants can be used specifically during sexual activity 1, 3
- Estradiol vaginal tablets 10 μg daily for 2 weeks, then twice weekly for maintenance, can be used as a low-dose vaginal estrogen formulation 1, 4
- Estradiol vaginal cream 0.003% (15 μg in 0.5 g) daily for 2 weeks, then twice weekly, can be used as a low-dose vaginal estrogen formulation 4
- Estradiol vaginal ring for sustained 3-month release can be used as a low-dose vaginal estrogen formulation 4
- Vaginal DHEA (prasterone) can be used as an alternative prescription option for postmenopausal dyspareunia 1, 2
- Ospemifene (oral SERM) can be used as an alternative prescription option for moderate to severe dyspareunia 2, 3
- Topical lidocaine can be used for persistent introital pain applied before penetration 1, 3
Contraindications and Safety Profile
- The established contraindications to vaginal estrogen therapy include current or history of hormone-dependent cancers (breast, endometrial, ovarian), undiagnosed abnormal vaginal bleeding, active or recent pregnancy, active liver disease, and recent thromboembolic events 1, 2
- Large prospective cohort studies of over 45,000 women show no concerning safety signals for stroke, venous thromboembolism, invasive breast cancer, colorectal cancer, or endometrial cancer with low-dose vaginal estrogen formulations 4