This review summarizes why low-dose vaginal estrogen is a reasonable, highly-effective option for genitourinary syndrome of menopause for most women with breast and gynecologic cancers using shared decision-making. First-line therapy remains non-hormonal vaginal lubricants/moisturizers paired with pelvic floor physical therapy, but this doesn’t provide complete relief for many women. Serum analyses confirm minimal systemic absorption with no clear increase in cancer recurrence or mortality even when used during endocrine therapy for ER+ disease, although one cohort suggested increased recurrence (not mortality) among women receiving aromatase inhibitors. | Burns, J Clin Oncol 2026
