Topical oestrogens should be used in the smallest effective amount to minimise systemic effects. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.
Most women will be able to comply with vaginal cream and this should be first choice.
These preparations may damage latex condoms and diaphragms – refer to individual manufacturer's Summary of Product Characteristics.
- Intravaginal cream 0.1% Ovestin®
providing 0.5mg estriol per applicatorful (£4.45 = 15g)
- Intravaginal cream 0.01% Gynest®
providing 0.5mg estriol per applicatorful (£24.98 = 80g)
- Cream 0.01%: insert 1 applicatorful daily, preferably in the evening until improvement occurs, reduced to 1 applicatorful twice a week; attempts to discontinue should be made at 3–6 month intervals with re-examination
- Cream 0.1%: 1 applicator-dose daily for 2–3 weeks, then reduce to twice a week; discontinue every 2–3 months for 4 weeks assessing need for further treatment. Local specialists may use alternative doses.
- One 80g tube of Gynest® provides 16 doses of treatment.
- One 15g tube of Ovestin® provides 30 doses of treatment
- The Gynest SPC states that the addition of a progestogen cyclically for at least 12 days per month/28 day cycle or continuous combined estrogen-progestogen therapy in non-hysterectomised women prevents the excess risk associated with estrogen-only HRT.
Estradiol vaginal tablet
- Vaginal tablets 10 micrograms (£16.72 = 24 tablets)
- Insert one tablet daily for 2 weeks, reducing to one tablet twice weekly
- Interrupt treatment periodically to assess for continued treatment.
Estradiol vaginal ring
- Vaginal ring 7.5 micrograms/24 hours (£31.42 = 1 ring (3 months treatment))
- Inserted into upper third of vagina and worn continuously; replace after 3 months; maximum duration of continuous treatment 2 years
7. Obstetrics, gynaecology, and urinary-tract disorders >
7.2 Treatment of vaginal and vulval conditions >
7.2.1 Preparations for vaginal and vulval changes
- First line
- Second line