Estrogen: we all have at least a little of it, but sometimes, we need a little more. The hormone estrogen has many uses, from helping out in the growth of secondary sex characteristics such as breasts, to influencing bone growth. If you need more estrogen than what's present in your body, it can be prescribed in many different forms: orally, through an injection, via a vaginal ring or vaginal suppository, or topically as a cream. Estrogen creams are particularly helpful for people going through menopause or who are postmenopausal, people experiencing vaginal dryness, and for transgender people as part of hormone replacement therapy.
Estrogen cream (as well as estrogen administered in other ways) is often prescribed to people going through the genitourinary syndrome of menopause (GSM). Symptoms include vaginal dryness, itching, irritation, and pain, as well as urinary symptoms such as frequent urination and urinary tract infections. “Vaginal estrogen cream reverses the cellular changes associated with the loss of estrogen at menopause and restores vulvar and vaginal tissues, thus relieving GSM symptoms,” explains Stephanie S. Faubion, MD, MBA, FACP, NCMP, IF, Medical Director of The North American Menopause Society. Another option would be a vaginal DHEA (prasterone), a prohormone that converts to estrogen and androgen.
Although postmenopausal people are the group most likely to be prescribed estrogen cream, others can use it in similar ways. “Sometimes premenopausal women using a birth control pill, and some women experience vaginal dryness after giving birth, can also benefit from the use of vaginal estrogen products,” Dr. Faubion says.
Trans folks may also use estrogen cream as part of hormone therapy. “The benefit of an estrogen cream is that it can be used to treat specific genital concerns in both trans men and trans women without significantly impacting their overall blood estrogen levels,” explains Kayla McLaughlin, a physician assistant who specializes in gender-affirming surgeries and a sexual health educator for transgender patients.
Transgender women are more likely to choose to take estrogen tablets or injections than creams, because creams have a lesser effect on increasing blood estrogen levels. However, if someone isn’t able to or doesn’t want to take a tablet or injectable estrogen, they might use an estrogen cream instead. “For example, if they have a history of blood clots, then transdermal options such as a patch or creams may be the only safe option available to deliver estrogen to the patient,” McLaughlin says. While estrogen creams are a lower-risk option than injections and tablets, she adds, “Anyone who takes estrogen in any form should have their blood levels checked on a regular basis by their doctor.”
Transgender men who take testosterone injections may also use estrogen cream on their genitals as a way to alleviate side effects. “Typically vaginal tissue, in the absence of estrogen, will become very dry and can cause significant discomfort,” McLaughlin explains. “Estrogen cream applied directly to the genital tissues can lessen these symptoms while not increasing their blood levels of estrogen, and therefore not triggering menstruation or interfering with blood testosterone levels.” Non-binary folks who do hormone replacement therapy might use estrogen cream, too.