Topical vaginal estrogen

What is topical vaginal estrogen?

This is a low dose, local estrogen therapy that comes in the form of creams and tablets. These are applied and inserted into the vagina respectively. It helps to relive the symptoms of vaginal atrophy by restoring the vaginal skin thickness, suppleness, addressing dryness and reducing the vaginal pH. The most common forms are Premarin cream and Vagifem tablets.

Is topical estrogen therapy safe?

As it is a local treatment i.e. applied only at the vagina, little or no estrogen is absorbed into the body. It is safe for long-term usage. Initiation therapy is usually daily for 2 weeks, followed by twice weekly dosing before bedtime for maintenance. Studies have not shown an increased risk of cancer recurrence even in women with a history of breast cancer. 

How do I apply topical estrogen therapy?

Premarin cream

• You may either use the applicator included in the box or your finger
• Wash and dry your hands thoroughly
• Apply a blueberry size (half your index finger tip) on your vaginal lips and the lower third of your vagina

Vagifem tablet

• Pass urine to empty your bladder before bedtime
• Wash and dry your hands thoroughly
• Lie down with your knees bent and legs slightly apart
• Remove pessary from wrapper
• Insert pessary (pointy end first) into the vagina as far as you can manage comfortably (usually about the length of your index finger)
• Wash your hands again and lie down to sleep 

Notes:

Avoid sex on the nights of application/insertion .

You should try not to pass urine for at least 2-3 hours after pessary insertion. The pessary will start to dissolve once it is inserted into your vagina. It is okay if you need to get up in the middle of the night to go to the bathroom and bits of it fall out.