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Low-Dose Vaginal Estrogen for Dryness and Atrophy

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Low-Dose Vaginal Estrogen for Dryness and Atrophy

Examples

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

Generic Name Brand Name
conjugated estrogens Premarin

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

Generic Name Brand Name
estradiol (low-dose) Estring

Vaginal tablet (inserted into the vagina twice per week)

Generic Name Brand Name
estradiol (low-dose) Vagifem

How It Works

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.

Why It Is Used

Since women are now generally discouraged from using long-term hormone therapy (HT)  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 HT or estrogen alone ( estrogen therapy, or ET ). 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.

Side Effects

Side effects may include:

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

Avoid using estrogen cream during sexual intercourse. A male sex 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.)

What To Think About

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 preventendometrial (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. 1

Talk to your doctor about using vaginal estrogen if you have had breast cancer.

 

References

Citations

  1. Shifren JL, et al. (2010). Role of hormone therapy in the management of menopause. Obstetrics and Gynecology, 115(4): 839–855.

Last Revised: June 21, 2012

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD – Internal Medicine & Donald Sproule, MD, CM, CCFP, FCFP – Family Medicine & Carla J. Herman, MD, MPH – Geriatric Medicine

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