Oestrogen vaginal cream

What is vaginal oestrogen?

Vaginal oestrogen is available as a cream or as pessaries that are inserted into the vagina. It is used to ease vaginal symptoms of menopause such as vaginal dryness, burning or itching.

Vaginal oestrogen may also be used to treat the vaginal tissues before and after vaginal surgery. Since vaginal oestrogen is applied directly into the vagina, less is absorbed into the body, reducing the chance of side effects.

In New Zealand, vaginal oestrogen is called Ovestin cream® and Ovestin pessaries®.

Dose

• Vaginal oestrogen is available as a vaginal cream or as pessaries.
• Symptoms of menopause: use every day until there is an improvement, and then two times a week for as long as is needed. It may take several days or even weeks before you notice an improvement in your symptoms. This treatment usually works well but the symptoms may come back after stopping the treatment.
• Vaginal surgery: use every evening for 2 weeks before surgery, then two times a week for 2 weeks after surgery.

How to use vaginal oestrogen 

Ask your doctor or pharmacist to explain how to use vaginal cream or pessaries. The following is a guide.

Vaginal cream

• Vaginal cream comes as a tube of cream together with special applicators that you need to fill with the cream. The applicator is used to measure the right dose of cream and enables insertion of cream inside your vagina. 
• Fill the applicator with cream to the ring mark (where the plunger stops). Do not completely fill the whole applicator. 
• Vaginal cream is best applied at night, before going to sleep.
• To clean the applicator, pull the plunger out of the barrel and wash both parts in
  warm, soapy water. Do not use detergents. Rinse well and dry afterwards. Do not put the applicator in hot or boiling water.
• If you forget a dose, use it as soon as you remember. But if it is the next day, just use the next dose at the right time. Do not use double the dose in one day.

Vaginal pessaries

• Vaginal pessaries are a moulded tablet that is inserted into your vagina.
• The pessary is best inserted at night, before going to sleep.
• You may need to moisten your first few pessaries with water before insertion if you are particularly dry and insertion feels uncomfortable.
• Remove one pessary from its wrapper. Either using a squatting position or lying on your back or side, insert the pessary deeply into the vagina.
• If you forget a dose, use it as soon as you remember. But if it is the next day, just use the next dose at the right time. Do not use double the dose in one day.

Precautions before using vaginal oestrogen 

• Do you have breast cancer?
• Are you pregnant or planning a pregnancy?
• Do you get unexplained vaginal bleeding?
• Do you have endometrial hyperplasia?
• Do you have liver disease, asthma, epilepsy, diabetes, or high blood pressure?
• Have you had a heart attack, stroke or blood clot in legs or lungs?
• Do you get migraine headaches?

If so, it’s important that you tell your doctor or pharmacist before you start using vaginal oestrogen. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What are the side effects of oestrogen vaginal cream?

Like all medicines, vaginal oestrogen can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Learn more

The following links have more information on vaginal oestrogen.
Ovestin Cream Medsafe Consumer Information
Ovestin Pessaries Medsafe Consumer Information

References

1. Vulvovaginal health in post-menopausal women BPAC, 2014
2. Estriol (vaginal) New Zealand Formulary

Additional resources for healthcare professionals

Topical oestrogens NZ Formulary