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.
If a topical oestrogen is to be used long-term consider co-prescribing an oral progestogen for 10-14 days each month to combat endometrial hyperplasia.
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 0.01% providing 0.5mg estriol per
applicatorful (£24.98 = 80g)
- Intravaginal cream 0.1% providing 0.5mg estriol per
applicatorful (£4.45 = 15g)
- 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 to assess need for further treatment)
- Topical oestrogens should be used in the smallest effective amount to
minimise systemic effects. It is recommended therefore that prescribers
initiate treatment with the lower strength preparation (0.01%) first line.
Estradiol vaginal tablet
- Vaginal tablet containing 10 micrograms of estradiol (£16.72 = 24 pack)
- Insert 1 vaginal tablet daily for 2 weeks then reduce to 1 tablet twice weekly
- Interrupt treatment periodically to assess for continued treatment.
Estradiol vaginal ring
- Vaginal ring releasing 7.5 micrograms estradiol in 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
- Intravaginal gel (£11.64 = 12 applicators)
- Symptomatic relief in women post-radiotherapy in whom alternative preparations have been unsuccessful
- One application three times a week, in the morning
- Treatment is to be initiated by an appropriate consultant
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