If you are taking anastrozole (Arimidex), letrozole (Femara), or exemestane (Aromasin) and dealing with vaginal dryness, you have probably already discovered that most of the standard solutions are complicated for you.
Your oncologist may have said something like "I would rather you avoid estrogen" and then moved on without a clear alternative. You left the appointment with a real problem and no real answer.
This article explains why these medications cause vaginal and vulvar dryness, why estrogen is often not an option, and what non-hormonal alternatives are supported by research.
Why Anastrozole, Letrozole and Exemestane Cause Vaginal Dryness
Anastrozole, letrozole and exemestane are aromatase inhibitors that reduce estrogen levels in the body. While effective for treatment, estrogen is also essential for maintaining vaginal and vulvar tissue health.
When estrogen drops, tissues become thinner, less elastic, and less lubricated. This leads to a condition called genitourinary syndrome of menopause (GSM).
More than half of women on these medications experience significant symptoms, making this a common and clinically important side effect.
Vaginal Dryness and Vulvar Dryness: What You Are Experiencing
Both internal (vaginal) and external (vulvar) tissues are affected.
Vaginal Symptoms
- Loss of natural lubrication
- Burning and irritation
- Thinning of vaginal walls
- Painful intercourse
- Higher risk of infections
Vulvar Symptoms
- Dryness and itching
- Burning and sensitivity
- Discomfort with clothing or sitting
- Thinning of external tissue
- Chafing or rawness
Why Estrogen Is Often Not an Option
The standard medical treatment for vaginal and vulvar dryness is local estrogen applied directly to the tissue through creams, rings or suppositories. For most women, local estrogen is considered low risk because very little is absorbed systemically.
For women with hormone receptor-positive breast cancer taking anastrozole, letrozole or exemestane, even small amounts of systemic estrogen absorption are a significant concern. A 2022 study published in the Journal of the National Cancer Institute found that vaginal estrogen therapy increased the risk of breast cancer recurrence by 39% in women specifically taking aromatase inhibitors. Most oncologists now advise against any estrogen for women on these medications.
That leaves a gap. And it is a gap that too many women are left to navigate on their own.
What the Research Actually Supports
- Hyaluronic acid vaginal suppositories have been studied as a non-hormonal alternative for vaginal dryness and GSM in women on aromatase inhibitors.
- Multiple peer-reviewed studies have found hyaluronic acid produces comparable improvements in vaginal dryness, tissue health and comfort to local estrogen.
- One prospective trial found that after 12 weeks of hyaluronic acid use, the proportion of women reporting vaginal dryness dropped from 97% to 26%.
- Hyaluronic acid does not interact with estrogen receptors and is not contraindicated for women with hormone receptor-positive breast cancer.
- Pelvic health specialists and oncology survivorship programs are increasingly recommending hyaluronic acid suppositories as a first-line non-hormonal option.
Non-Hormonal Options That Work
1. Hyaluronic Acid Vaginal Suppositories
Hyaluronic acid is a molecule found naturally throughout the body. It is best known for attracting and retaining water, holding up to 1,000 times its weight in moisture. When delivered as a vaginal suppository, it works directly on the mucosal lining of the vagina, restoring hydration and helping to soothe and support tissue that has thinned from anastrozole, letrozole or exemestane.
Unlike estrogen, hyaluronic acid is completely non-hormonal. It does not interact with estrogen receptors and is not contraindicated for women with hormone receptor-positive breast cancer.
HAPure by NewLife Naturals (currently available as HA Inserts, being renamed to HAPure) contains 5mg of hyaluronic acid sodium salt. It is naturally derived, estrogen free, non-GMO and paraben free. A 510k application is currently in final preparation with the FDA, and a clinical study at a major US hospital group is underway examining HAPure specifically for women on AI treatment. Pre-study clinician response has been strongly positive.
For women with more advanced atrophy, HAPure Ultra is coming soon with a higher concentration of hyaluronic acid for increased support.
2. Vitamin E Vaginal Suppositories
Vitamin E is a fat-soluble antioxidant with anti-inflammatory and tissue protective properties. When used vaginally, it helps soothe irritated tissue and provide a protective effect that supports comfort alongside hyaluronic acid.
ESoothe Ultra by NewLife Naturals is a high potency vitamin E vaginal suppository particularly well suited for women on anastrozole, letrozole and exemestane who need additional soothing support alongside internal hydration. For women who prefer a gentler starting point, E-Soothe Inserts (soon to be renamed ESoothe) is a lower potency option.
NewLife Naturals is also introducing HAPure with Vitamin E, a single suppository combining hyaluronic acid and vitamin E for women who want both hydration and soothing support in one step.
3. Vulvar Balms for External Dryness
A vaginal suppository addresses the internal vaginal canal. It does not reach the external vulvar tissue where many women on anastrozole, letrozole and exemestane experience equally significant dryness, itching and sensitivity.
A clean, naturally derived vulva balm applied externally provides direct moisture and soothing to tissue that has thinned from the effects of these medications. NewLife Naturals vulva balms are formulated with certified organic ingredients including calendula and vitamin E, jojoba and moringa, and shea butter and almond oil, designed specifically for sensitive vulvar tissue.
4. Pelvic Floor Physical Therapy
Pelvic floor physical therapy is one of the most effective an d most underutilized interventions for women experiencing vaginal and vulvar dryness from anastrozole, letrozole and exemestane. A specialized pelvic floor PT addresses not just dryness but the muscular tension, reduced elasticity and pain during intercourse that often develop alongside it. Ask your oncologist for a referral or search the APTA pelvic health specialist directory.
Recommended Non-Hormonal Routine
- Hyaluronic acid suppository 2–3 times per week
- Vitamin E suppository on alternate days
- Daily use of vulvar balm
- Pelvic floor therapy if pain is present
Most women notice improvement within 2–4 weeks with consistent use.
Talking to Your Doctor
Bring this up with your oncology team. You can say:
- "I am experiencing vaginal dryness. What non-hormonal options can I try?"
- "Is hyaluronic acid safe for me to use?"
- "Can I get a referral for pelvic floor therapy?"
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult your oncologist or healthcare provider before starting any new product or treatment during or after cancer therapy.
