FAQs: Vaginal Oestrogens

No. Vaginal oestrogen is a local treatment. It works mainly in the vaginal and urinary tissues and only tiny amounts enter the bloodstream. Systemic HRT (tablets, patches, gel or spray) treats whole-body symptoms like hot flushes.

More information:
https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/

No. Because the absorbed dose is very low, progesterone is not needed to protect the womb lining when using low-dose vaginal oestrogen alone.

Yes. There is no time limit for use. Many women use it for years if symptoms persist. Once symptoms have improved, usually after 3-6 months of use, then a trial off treatment can be attempted. Stopping can lead to symptoms returning and treatment can be resumed in this case, restarting on nightly application for 2 weeks before continuing on maintenance therapy. The British Menopause Society supports long-term use when needed. Some women may find using vaginal oestrogen less frequently, for example once weekly, or reducing the amount used will continue to control symptoms.

This depends on your individual situation. Because absorption is minimal, specialists may sometimes prescribe it after discussion of risks and benefits. You should speak to your GP, oncologist or menopause specialist before starting.

Yes. Many women on systemic transdermal oestrogen (e.g. oestrogel, Lenzetto spray), patches or oral HRT tablets, still need vaginal oestrogen for local symptoms. Systemic HRT does not always fully treat vaginal dryness or urinary issues.

No special adjustments are needed. Vaginal oestrogen can be used whether or not you have had a hysterectomy.

Yes. Restoring oestrogen improves the health of tissues around the bladder and urethra and can reduce recurrent UTIs in menopausal women. It is often recommended as part of prevention.

It may improve comfort during sex by reducing dryness and pain. However, it does not directly increase libido. If low sex drive is a concern, speak to a clinician about other options.

Low-dose vaginal oestrogen is not associated with the same risks as systemic HRT because absorption into the bloodstream is very small. Studies have not shown any significant increase in blood clots, stroke or breast cancer when using vaginal oestrogens. The patient information leaflets within the product packaging may list these risks due to generic warnings for all hormone products. These generally apply to systemic full body HRT rather than local vaginal treatments.

Use it when you remember, unless it is nearly time for your next dose. Do not double up. Missing occasional doses is unlikely to cause harm but symptoms may gradually return if multiple doses are forgotten.

Yes. Vaginal and urinary symptoms can start before periods stop completely. Treatment can be used if symptoms are due to low or fluctuating oestrogen levels before menopause.

Creams can feel slightly messier and may leak a little after application. Using them at night and wearing a light liner can help. Pessaries are often less messy or using a vaginal cream option that delivers the dose in a smaller volume per application e.g. Estriol 1mg/g. Blissel gel is water based and considered less messy but contains a lower dose of estriol per application.

Yes. It’s best to apply at bedtime so the treatment stays in place overnight. Bathing or swimming the following day will not affect it.

Yes. Vaginal moisturisers can be used regularly alongside oestrogen. Water-based lubricants can be used during sex. Try to apply them at a different time of day from oestrogen treatment.

Possible reasons include:

• Not using it regularly enough.
• Not filling applicator with correct amount of treatment.
• Incorrect placement high in the vagina (upper third of vagina).
• Needing a slightly higher maintenance dose.
• Another condition such as infection.

If symptoms persist, please arrange a review with a clinician.

Light spotting can occur in the first few weeks. However, any unexplained bleeding after the first 3 months should be checked by your GP as it could be a symptom of endometrial cancer.

Often yes, but this should be discussed with your specialist. It may improve comfort and tissue health after cancer treatment.

No. It does not interfere with cervical screening. In fact, using vaginal oestrogen for a few weeks before a smear can sometimes make the test more comfortable.

NHS cervical screening information:
https://www.nhs.uk/conditions/cervical-screening/

There is no single best option. Choice depends on:

• whether symptoms are internal, external or both.
• Preference for cream/gel vs pessary tablet.
• Ease of use.
• Sensitivity to ingredients.

Some women prefer estriol creams for external dryness; others prefer estradiol pessaries for convenience.

Maybe. Vaginal oestrogens do not work as contraceptives.

No - not taking any hormones (contraceptives or HRT) and have not had a period for over a year over age 50 or for over 2 years under age 50. Or if you have had a hysterectomy.

Yes - over age 50 and have had a natural period in the last year, or under age 50 and have had a period in the last 2 years. Contraception should be continued until age 55. This could be condoms, a coil (IUD), progesterone only pill (POP), implant or hormone releasing intrauterine system (IUS) or if under 50 years a depot injection.