7.2.1 Preparations for vaginal and vulval changes

Hormonal preparations

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.

Estriol
  • 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)

Indications

  • Vaginal atrophy

Dose

  • 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)

Notes

  1. 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)

Indications

  • Vaginal atrophy

Dose

  • Insert 1 vaginal tablet daily for 2 weeks then reduce to 1 tablet twice weekly

Notes

  1. 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))

Indications

  • Vaginal atrophy

Dose

  • Inserted into upper third of vagina and worn continuously; replace after 3 months; maximum duration of continuous treatment 2 years

Non-hormonal preparations

ReplensMD®
  • Intravaginal gel (£11.64 = 12 applicators)

Indications

  • Symptomatic relief in women post-radiotherapy in whom alternative preparations have been unsuccessful

Dose

  • One application three times a week, in the morning

Notes

  1. Treatment is to be initiated by an appropriate consultant

 

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