Introduction
Once you start going down the rabbit hole of Google, you’ll come across many different treatments and ways to manage your lichen sclerosus. One thing that may come up in your search is estrogen therapy. Conversely, you may have heard others talking about their using estrogen in virtual meetups or support groups. Regardless of where you heard about estrogen, you may be wondering if you need to be on estrogen if you have lichen sclerosus. And this is a good and important question, and we address it in today’s post.
Disclaimers
*This post is evidence-based; I draw on the medical literature to share what you need to know about lichen sclerosus and estrogen. Importantly, what I share is my interpretation of the science and data.
**The information contained in this blog post is up-to-date at the time of publication.
***If this post is helpful to you, we’d love your support so we can continue providing important education like this. Make a donation today, volunteer with us, or share our posts in your support groups.
Treatment versus Adjunct Therapy
First things first. When addressing the question of whether you need to be on estrogen if you have lichen sclerosus, we need to get clear on some important medical terminology.
Treatment: The definition of treatment is, “Medical treatment means the management and care of a patient to combat condition or disorder” (University of Wisconsin). Treatment can either manage a condition or cure the condition.
Primary Treatment: A primary treatment is the main treatment used to manage or cure a condition. It is often the one that has the most scientific evidence behind it and the best success rate.
Adjunct Therapy: According to the NIH and the National Cancer Institute, adjunct therapy is “Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. Also called adjunctive therapy”.
Keep these terms in mind as you move through this blog post.
What is Estrogen?
Estrogen is a hormone that plays an important role in the female reproductive system. It can help regulate your menstrual cycle and support bone health. Estrogen also has protective health benefits on our cardiovascular system (e.g., your heart and blood vessels) and may help lower the risk of heart disease in premenopausal people. In terms of brain health, estrogen can influence our mood and cognition.
Estrogen is in the family of hormone; the hormone you are actually using is estradiol. We use estrogen for simplicity.
It is normal for estrogen levels to fluctuate throughout your life.
Sometimes, our bodies do not produce enough estrogen. This can be due to aging (menopause) or certain medical conditions.
Estrogen therapy involves using estrogen to either balance or replace the natural estrogen in the body, especially as we age. Estrogen therapy can be delivered through topical creams and gels, patches, pills, etc.
What Does the Science Say on Estrogen as a Treatment for Lichen Sclerosus
One of the first things your doctor will want to do for lichen sclerosus is get you on an evidence-based treatment. That will be your primary treatment plan. So, you may be wondering, is estrogen therapy a treatment for lichen sclerosus?
In the past, hormone therapy was used to treat lichen sclerosus. However, studies showed that estrogen (and other hormone therapies such as testosterone and progesterone) were not helpful as a treatment for lichen sclerosus. Often, these therapies had the same effect as placebo (Bracco et al., 1993; Sadowska‐Przytocka, 2012).
Therefore, estrogen and hormone therapy alone is no longer recommended as a treatment/primary treatment for lichen sclerosus by dermatologists, gynecologists, and vulvovaginal specialists.
Do You Need to Be on Estrogen if You Have Lichen Sclerosus?
The short answer is no; you do not need to be on estrogen if you have lichen sclerosus.
However, the longer, more complex answer is that for some folks, adding topical estrogen to the vulva can, in some cases, be beneficial as an adjunct to your primary treatment plan.
Remember that the role of adjunct therapies is to assist the primary treatment. Think of it this way. Adjunct therapies and add-ons like hormone therapy, pelvic floor physical therapy, barrier creams, and emollients can help stack the cards in your favor to help boost your treatment plan and help your overall quality of life.
So, how can estrogen help as an adjunct/add-on to your primary treatment plan?
According to Drs Goldstein and Krapf, estrogen applied topically to the vulva can help improve the vulvar tissue’s elasticity, moisture, and overall health. In fact, they will sometimes compound estrogen and testosterone into a gel to be applied to the vulva (Goldstein, Pukall, Goldstein, and Krapf, 2023).
When to Consider Estrogen?
In addition to what we said about estrogen being a helpful adjunct/add-on, estrogen can also be helpful if you have LS and genitourinary syndrome of menopause (GSM). You can learn more about GSM here.
How to Talk to Your Doctor about Estrogen?
Talking to doctors can be intimidating, especially if healthcare providers have mistreated you in the past. Here are some tips for talking to your healthcare providers about estrogen therapy.
-Find someone comfortable with hormones (e.g., a vulvar specialist or a NAMS–North American Menopause Society–certified practitioner). You can find a provider directory of NAMS-certified providers here.
-Bring studies supporting topical estrogen safety
-Be transparent about why you want it and that you understand its limitations – be clear that you understand it is an adjunct
-Consider booking a telehealth appointment with a vulvar specialist who can draft a recommendation sheet for your doctor (e.g., Dr. Corey Babb and Dr. Jill Krapf).
Want to Learn More about Hormones and Lichen Sclerosus?
Check out this video I did with Dr. Corey Babb below. It’s incredibly insightful and informative.
Conclusion on Do You Need to Be on Estrogen if You Have Lichen Sclerosus?
In sum, while topical estrogen alone is not a treatment for vulvar lichen sclerosus, it may have its place as an adjunctive therapy to help with vulvar tissue health. Of course, if you are dealing with genitourinary syndrome of menopause, topical estrogen may also be beneficial. It is important to discuss risk versus benefits of using topical estrogen with vulvar lichen sclerosus with your healthcare provider to determine the best course of action for you and your body.
Let us know if you you use estrogen and if you’ve seen any benefits
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References
Gian Luca Bracco, Carli, P., L Sonni, G Maestrini, Alberto De Marco, Gian Luigi Taddei, & Cattaneo, A. (1993). Clinical and histologic effects of topical treatments of vulval lichen sclerosus. A critical evaluation. PubMed, 38(1), 37–40.
Goldstein, A., Pukall, C., Goldstein, I., & Dr. Jill Krapf. (2023). When Sex Hurts. Hachette Go.
Sadowska-Przytocka, A., Aleksandra Dańczak-Pazdrowska, Szewczyk, A., Czarnecka-Operacz, M., Dorota Jenerowicz, Agnieszka Osmola-Mańkowska, & Karolina Olek-Hrab. (2012). Treatment of genital lichen sclerosus in women–review. PubMed, 83(6), 458–461.
I have been doing PRP for my Lichen Sclerosis . This has truly helped but expensive. Treatment every 8 to 12 months. Insurance doesn’t pay but it is worth it for me. Not using any hormone treatment at this time> Im 68 years old.
Thank you for sharing what’s worked for you! We love hearing from the community.
My 82-year-old relative had been on twice-weekly mometasone furoate and topical estradiol for LS, and this week they replaced the mometasone with clobetasol. The initial recommendation is twice daily clobetasol for the first month and once daily for the second (tapering to twice daily maintenance), while maintaining a twice-weekly estradiol application. She’s concerned about how and when to apply the medications on the days she uses both. Would she apply the estradiol or the clobetasol first, and would she need to wait between the applications? Would the soaking recommendation be different on the estradiol days? They have her using the estradiol on the vestibule of the vaginal opening, but weren’t super-specific as to the clobetasol (so your application article is a godsend!). There’s also a biopsy site that was rather (in our opinion) clumsily incised, so she’s never sure if that’s scar tissue or LS (her derm feels it’s the LS). We find your site so valuable, though it’s so sad that everyone’s doctors aren’t this helpful!
Thank you for reaching out, Elizabeth! You are so kind for helping your relative understand their condition. We’ve had several different experts express you can use the steroid and estrogen at the same time. I hope her biopsy incision has healed by now. Please let me know if you have any other questions. 🤗🥰
I am on estrogen replacement therapy, (which thankfully more MDs are seeing the benefits of continuing) and my first flareup and diagnosis of lichen sclerosus was when I could not afford my Rx. I am on Premarin, which has no generic and insurance will not cover. It cost over $250.00 a month. I am currently being treated by an MD with steroids, etc. It has been helpful. I also began using a mild topical estrogen, (also diagnosed with genitourinary syndrome). My PCP recently passed away and using a new MD. Bottom line, the treatments for my lichen sclerosis are helpful, but without the oral estrogen, I am in a continuous flareup. There is no history of breast cancer on my maternal or paternal family for 2, maybe more generations. I believe, in my case, there is a strong estrogen component with lichen sclerosis and flareups, and in the syndrome’s initial manifestation.