Low-dose vaginal estrogen for dryness and atrophy

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Vaginal estrogen cream (cream inserted into the vagina that releases estrogen continuously)

Vaginal estrogen ring (inserted high in the vagina, releases daily estrogen for 3 months)

Vaginal tablet (inserted into the vagina twice per week)

A low dose of estrogen released into the vaginal area has a localized effect (only a small amount of estrogen is absorbed into the bloodstream). This rebuilds the lining of the vagina and urethra by promoting collagen production.

A typical schedule for low-dose prescription estrogen cream is 3 weeks of daily use followed by twice-weekly use thereafter.

For dryness and irritation of the external vaginal area (labia) only, you can rub a small amount of estrogen cream onto the affected area. Many women find that twice a week is often enough.

Since women are now generally discouraged from using long-term hormone replacement therapy (HRT) because of health risks, low-dose vaginal estrogen is recommended for treating vaginal and urethral (genitourinary) dryness and weakening after menopause. Because it is low-dose and has a localized effect, it is thought to be a lower-risk treatment than HRT or estrogen alone (estrogen replacement therapy, ERT). Low-dose estrogen absorbed vaginally:

• Helps maintain the muscle tone of the vagina and urethra.
• Reduces vaginal dryness, irritation, and pain.
• Reduces urinary tract irritation and tendency toward infection.

You can expect noticeable improvement in vaginal dryness and sensitivity after a few weeks of vaginal estrogen treatment. You will likely continue treatment as long as you have symptoms.¹

Side effects may include:

• Abnormal vaginal bleeding.
• Breast pain.
• Nausea.

Avoid using estrogen cream during sexual intercourse. A male sexual partner regularly exposed to estrogen cream can develop enlarged breasts.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Vaginal estrogen may be used by women with liver or gallbladder disease, for whom oral estrogen is not recommended.

Low-dose vaginal estrogen is generally not accompanied by progestin to prevent endometrial (uterine) cancer because it is a lower dose and is thought to have only a local effect. Use as low a dose as possible to relieve symptoms.

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Citations

1. North American Menopause Society (2007). The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause, 14(3): 357–369.