Despite the increasing incidence of endometrial cancer in young women, there is limited research on the safety of topical low-dose vaginal estrogen therapy (ET) in survivors. New research suggests that this form of estrogen is not only effective in relieving many menopausal symptoms, but also does not appear to increase a woman’s risk of cancer recurrence. The research results will be published online today. menopauseJournal of the Menopause Society.
Until recently, all hormone therapies that included topical low-dose vaginal estrogens had the same black box warnings as high-dose systemic therapies, even though topical low-dose vaginal estrogen options have limited, local effects (i.e., minimal absorption into the body). Despite its proven benefits in managing many menopausal symptoms, such as vaginal dryness, painful intercourse, and urinary problems, many women may be deterred from using vaginal ET due to fear of potential side effects.
Women being treated for endometrial cancer commonly require a hysterectomy with bilateral salpingo-oophorectomy or other treatments such as radiation therapy or chemotherapy to induce early menopause. Early menopause is usually accompanied by hot flashes, night sweats, and worsening genitourinary symptoms. The incidence of early-onset endometrial cancer in American women under age 50 has steadily increased from 2.2 to 3.3 per 100,000 women between 2000 and 2019, meaning more women are developing endometrial cancer at a younger age. Because of fear of ET, these women are commonly prescribed non-hormonal treatments for menopausal symptoms, but these have limited efficacy.
A new study, based on electronic health records and insurance claims data from 68 healthcare institutions involving more than 2,800 women between the ages of 18 and 51 diagnosed with endometrial cancer, aims to evaluate the use of topical low-dose vaginal ET and the outcomes associated with its use in younger survivors of endometrial cancer. The mean ET treatment duration was 1.88 years.
Based on this result, the researchers concluded that initiation of vaginal ET is minimal (estimated at 5.6%) in young survivors of endometrial cancer. However, survivors with short-term exposure to vaginal ET had no increased risk of endometrial cancer recurrence compared with women who did not use that treatment option. This is the largest known U.S. study evaluating endometrial cancer recurrence with topical low-dose intravaginal ET use in endometrial cancer survivors.
The study results are published in the paper “Use of vaginal estrogen therapy and associated outcomes in young survivors of endometrial cancer.”
Thanks to early detection and improved targeted therapies, more women are surviving a diagnosis of endometrial cancer. However, the after-effects of these life-sustaining treatments often cause serious impairments in quality of life and sexual function. Genitourinary symptoms associated with menopause rarely improve without treatment and worsen if menopause occurs suddenly and early. Helping endometrial cancer survivors make evidence-based decisions about their care is especially empowering at a time of vulnerability. Expanding treatment options to include topical low-dose vaginal estrogen therapy for this population will have long-term benefits. ”
Dr. Monica Christmas, Associate Medical Director, Menopause Medicine Society
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Reference magazines:
Sue, CD, others. (2026) Utilization of vaginal estrogen therapy and associated outcomes in young survivors of endometrial cancer. menopause. DOI: 10.1097/GME.0000000000000002747. https://journals.lww.com/menopausejournal/abstract/9900/vaginal_estrogen_therapy_utilization_and.620.aspx
