Vaginal Oestrogen HRT

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

After menopause, oestrogen levels drop. This can cause the skin around the vagina and vulva to become thinner and drier. You may notice:

• Vaginal dryness or soreness.
• Discomfort or pain during sex.
• More frequent urinary symptoms.
• Increased urinary infections.

Vaginal oestrogen is a local form of HRT and can help to relieve these symptoms, which are termed genitourinary syndrome of menopause (GSM).

It does not help with other menopausal symptoms such as hot flushes, night sweats or mood changes, which systemic (whole body) HRT can be used to treat.

Vaginal oestrogen treatment

Vaginal oestrogen treatment available from Dr Fox includes:

• Vaginal creams and gel: Estriol 0.01% cream, Estriol 1mg/g (Ovestin) cream, Blissel gel.
• Vaginal pessary tablets: Vagifem 10 micrograms, Vagirux 10 micrograms.

How does vaginal oestrogen treatment work?

Vaginal oestrogen is a form of hormone replacement therapy (HRT) that is applied directly inside the vagina. It increases blood flow, restoring thickness, and moisture of the vaginal walls and urethral tissue, helping reverse the thinning (atrophy) that occurs with low oestrogen levels.

Because only very small amounts are absorbed into the bloodstream:

• The effects are mainly local.
• The risks are much lower than with systemic HRT (tablets, patches, spray or gel).
• Progestogen does not need to be taken alongside vaginal oestrogen.

Who can benefit from vaginal oestrogen treatment?

Vaginal oestrogen treatments are suitable for most women with menopausal vaginal or urinary symptoms listed above. They usually take a few weeks to start improving symptoms and can be used on their own or alongside systemic HRT. Vaginal creams and gel can be particularly helpful for dryness, as they also provide a moisturising effect.

Despite vaginal oestrogen causing much less risk than systemic HRT, manufacturers generally advise against its use if a woman has been advised not to use systemic HRT. However, after careful assessment, a GP or gynaecologist may prescribe vaginal oestrogen in these cases.

There is a short online medical questionnaire to ensure treatment from Dr Fox is suitable.

Dosage of vaginal oestrogen treatment

Vaginal oestrogen creams, gel and pessaries:

• Initial treatment: use nightly for 2 weeks.
• Maintenance treatment: use twice weekly, spaced 3-4 days apart.

These are put into the top of the vagina using the supplied applicator.

Use only one of these treatments at a time. Do not use them together. It is advised to use the lowest dose that controls symptoms.

Treatment can be continued as long as symptom control is needed. It is advised to see your GP for a review 3 months after starting or changing vaginal oestrogen treatment and you can message our doctors at any time from your account.

Vaginal oestrogen cream and gel options

Vaginal creams and gel contain the oestrogen hormone estriol. They work in the same way, although the dose of oestrogen differs between products and the amount of product dispensed in each application.

Product	Type	Estriol per gram	Grams in each application	Estriol per application
Estriol 0.01%	cream	0.1mg	5g	0.5mg
Estriol 1mg/g 0.1% (Ovestin)	cream	1mg	0.5g	0.5mg
Blissel*	gel	0.05 mg	1g	0.05mg

^*Blissel gel is a low strength vaginal oestrogen option

Vaginal oestrogen pessary options

Vagifem and Vagirux vaginal tablets (pessaries) contain 10 micrograms of 17-β oestradiol, a bioidentical oestrogen (the same type produced naturally by the body before menopause).

• Vagifem: single-use applicator.
• Vagirux: reusable applicator (discard after 24 uses).

Who should NOT use vaginal oestrogen treatment?

You should not use vaginal oestrogen if you are allergic to any of the ingredients.

Allergy information

• Estriol 0,01% cream contains peanut oil - avoid if you are allergic to peanuts or soya.
• Estriol 1mg/g 0.1% (Ovestin), Blissel, Vagifem, and Vagirux do not contain common allergens.

Checks are included in the online consultation. For a full list of contraindications, see the manufacturer's patient information leaflet.

Vaginal oestrogen treatment and other medicines

Vaginal oestrogen treatment rarely interacts with other medicines.

• Avoid using at the same time of day as other vaginal products.
• Vaginal pessaries do not affect condoms.
• Vaginal creams and gel may damage condoms and diaphragms — leave 72 hours between use.

Vaginal oestrogen treatment - possible side effects

It is not usual to have side effects but these can include:

• Local irritation or discomfort.
• Headache or abdominal discomfort.
• Vaginal discharge.

Stop treatment and see a doctor immediately if you get:

• Signs of an allergic reaction.
• Yellow skin or eyes (jaundice).
• A sudden, severe headache or migraine.
• Swelling in one leg, chest pain, or difficulty breathing (possible blood clot).
• High blood pressure.
• Pregnant.

Important: Any unexplained vaginal bleeding after the first 3 months of treatment should be investigated by your GP.

Buy treatment

Dr Fox pharmacy supplies vaginal oestrogen treatments on prescription. You are required to complete a short medical questionnaire before ordering.

Supplementary information

Vaginal dryness fact sheet
Urogenital problems fact sheet

Buy treatment

Dr Fox pharmacy supplies vaginal oestrogen treatments on prescription.
You are required to complete a short medical questionnaire before ordering.

1. Medical questions
2. Choose treatment
3. Complete order

Answer medical questions to order(vaginal oestrogens)

Honest & accurate responses are necessary for safe medical assessment