It is true that less is absorbed by a topical application than by an oral application, so in this manner is vaginal Estrace "less risky" than the oral.  

However, estradiol blood levels are raised by vaginal applications of estrogen preparations, although VagiFem vaginal tablets carry less estrogen than the Estrace cream, which is fairly concentrated.

Most women must weigh the risks and benefits, as some women in whom surgical mesh has been placed will be told by their surgeons that they must use topical estrogen for the rest of their lives to keep vaginal and vulvar tissues from thinning so much that the mesh pokes through and causes complications.

Numerous studies document the increased risks for stroke, breast cancer, gallbladder disease, heart disease, and blood clots, when pharmaceutical or bioidentical estrogen is taken, although the amount each women absorbs will vary depending on her medical condition and the method and size of the dose.

The most famous of these studies was the Women's Health Initiative.  Then there was the WEST study (Women's Estrogen for Stroke Trial) which documented an increase risk with some forms of estrogens for blood vessel inflammation and clotting.

These references below came from this study Transdermal vs. Oral Estrogen: Which is More Effective?
By WorldLink  and the ideas above were inspired by Celeste Robb-Nicholson, M.D.Editor in Chief, Harvard Women's Health Watch and also by Dr. Anthony Komaroff, of the Harvard Medical School.

1. Billeci AM, Paciaroni M, Caso V, Agnelli G. Hormone replacement therapy and stroke. Curr Vasc Pharmacol. 2008;6(2):112-123.
2. Chu MC, Cosper P, Nakhuda GS, Lobo RA. A comparison of oral and transdermal short-term estrogen therapy in postmenopausal women with metabolic syndrome. Fertil Steril. 2006;86:1669-1675.
3. Hendrix SL, Wassertheil-Smoller S, Johnson KC, et al. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation. 2006;113:2425– 2434.
4. Ho JY, Chen MJ, Sheu WH, Yi YC, Tsai AC, Guu HF, Ho ES. Differential effects of oral conjugated equine estrogen and transdermal estrogen on atherosclerotic vascular disease risk markers and endothelial function in healthy postmenopausal women. Hum Reprod. 2006;21(10):2715-2720.
5. Mendelsohn ME, Karas RH. Protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999;340:1801–1811.
6. Menon DV, Vongpatanasin W. Effects of transdermal estrogen replacement therapy on cardiovascular risk factors. Treat Endocrinol. 2006;5(1):37-51.
7. Nelson HD, Humphrey LL, Hygren P, Teutsch SM, Allan JD. Postmenopausal hormone replacement therapy. Scientific review. JAMA 2002;288:872–881.
8. North American Menopause Society. Amended report from the NAMS Advisory Panel on postmenopausal hormone therapy. Menopause. 2003;10:6-12.
9. Scarabin PY, et al. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003;362(9382):428–432.
10. Smith NL, Heckbert SR, Lemaitre RN, Reiner AP, et al. Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis. JAMA. 2004 Oct;292(13):1581-1587.
11. Vehkavaara S, Silveira A, Hakala-Ala-Pietila T, Virkamaki A, et al. Effects of oral and transdermal estrogen replacement therapy on markers of coagulation, fibrinolysis, inflammation and serum lipids and lipoproteins in postmenopausal women. Thromb Haemost. 2001;85(4):619-625.
12. Verhoeven MO, Hemelaar M, Van Der Mooren MJ, Kenemans P, Teerlink T. Oral, more than transdermal, oestrogen therapy lowers asymmetric dimethylarginine in healthy postmenopausal women: a randomized, placebo-controlled study. J Intern Med. 2006;259:199-208.
13. Viscoli CM, Brass LM, Kernan WN, Sarrel PM, et al. A clinical trial of estrogen replacement therapy after ischemic stroke. N Engl J Med. 2001;345:1243-1249.
14. Vongpatanasin W, et al. Differential Effects of Oral Versus Transdermal Estrogen Replacement Therapy on C-Reactive Protein in Postmenopausal Women . J of Amer Coll Cardio. 2003;41(8):1358–1363

Interesting to hear your caution about Estrace. Are we talking about the cream that is dabbed into the vagina?  I thought taking it in that way rather than orally was quite safe. Have there been studies done specifcally on Estrace to show potential cancer promotion and blood clots that show this to be a danger? Might you have a link? 

Thank you Angela, for being a member here at www.DrCarney.com and posting your question. It's an important one, because I believe that Estrace increases our risk for many health problems, including cancer, overweight, clots, memory loss, and high blood pressure, as do all pharmaceutical estrogens and bioidentical estrogens.

This question, like many regarding the delicate subject of sexual intimacy, requires a private custom coaching consult to answer properly, as many questions need to be asked (by me of you) in order for me to make an accurate recommendation.

https://www.vegvor.com/advice/half-hour-custom-coaching-consultation

I would not want to compromise your privacy by discussing this openly here, but I do feel that offering hope through a private phone consult has been thought worth the time by those who have tried it before.

In the meantime, Astroglide?  or http://aloecadabra.com/ ?

Best Wishes, 

Dr. Carney

www.AllMedPhysicians.com