How do you reason the risk and benefits of low dose vaginal estrogen to a patient on an AI for postmenopausal breast cancer that is suffering from symptomatic vaginal atrophy?

At our Center, we have step-wise approach to vaginal dryness/dyspaurenia. First, establish whether the vaginal dryness is problematic. Most often, the vaginal dryness in-of-itself does not cause problems that impact quality-of-life. The major problem is painful intercourse. Step 1 is the non-hormona...

It is a risk to benefit decision. Balancing a known benefit (e.g., in terms less dyspareunia) against a non-quantifiable, but likely low risk of doing harm. I believe individuals can and do make these decisions all the time. Absolute safety of most drugs cannot be assured.