What is Estriol cream?

• Estriol is a form of oestrogen that is produced naturally by the body.

Estriol cream can usually be used by women who can't or don't want to use HRT tablets or patches.

What is estriol cream used for?

• Estriol cream is used to relieve vaginal dryness, itching or irritation associated with the menopause. The cream is inserted into the vagina using an applicator.
• Estriol cream is also sometimes used to treat the vaginal tissues before and after vaginal surgery, such as vaginal prolapse.

How does estriol cream work?

• Estriol is a form of oestrogen that is produced naturally by the body. The cream works by directly supplementing the vaginal tissues with oestrogen.
• Ovaries gradually produce less and less oestrogen in the period up to the menopause, which can cause distressing symptoms and can often affect the delicate lining of the vagina. Oestrogen deficiency can cause vaginal dryness, inflammation or itching and this in turn can lead to sex being uncomfortable or painful, as well as making you more susceptible to vaginal or urinary infections.
• Directly supplementing the vaginal tissues with oestrogen helps relieve vaginal dryness, itching and irritation and it's associated problems. It may take a few weeks before you notice an improvement.

Key points

• You insert the cream daily before going to bed for 2 to 3 weeks, then reduce to twice a week.
• Symptoms will usually return when you stop using the cream. You can keep using it for as long as you need to, but you should have a check up with your doctor at least once a year.
• Estriol cream can damage condoms and diaphragms so they won't work to prevent pregnancy or STIs.
• Side effects from using vaginal oestrogen are very rare.
• See your doctor if you get any unusual vaginal bleeding.

Who should not use Estriol cream?

Estriol cream is only absorbed into the bloodstream in very low amounts from your vagina, so it doesn't carry the same risks as using hormone replacement therapy tablets or patches. It's usually fine for most women to use it. However, make sure your doctor knows if:

• you have abnormal vaginal bleeding that hasn't been investigated by a doctor
• you have ever had cancer of your womb lining (endometrial cancer), overgrowth of your womb lining (endometrial hyperplasia), endometriosis or fibroids in your womb
• you, your mother, sister or grandmother have ever had breast cancer
• you have ever had benign breast lumps (fibrocystic breast disease)
• you or a close family member have ever had a blood clot in a vein of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism)
• you have ever had angina pectoris, a heart attack or a stroke
• you have an increased risk of getting blood clots, eg due to blood disorders such as antiphospholipid syndrome, factor V Leiden, protein c, protein s or antithrombin deficiency
• you have high blood pressure (hypertension)
• you have liver problems
• you have a rare metabolic disorder known as porphyria
• you have ever had gallstones
• you have diabetes
• you suffer from migraines or severe headaches.
• You shouldn't use estriol cream if you are pregnant or breastfeeding.

How to use Estriol cream

• Use the applicator provided to insert a measured dose of cream into your vagina before going to bed. Follow the instructions provided with your vaginal cream carefully.
• For vaginal problems associated with the menopause your doctor will usually ask you to insert one applicatorful of cream every night for two to three weeks, then reduce to twice a week as your symptoms improve.
• It's a good idea to stop treatment every few months to see if you still need it, but symptoms can often come back when you stop using the cream.
• You can keep using the cream for as long as you need to, but you should have a check up with your doctor at least once a year.

Side effects of Estriol cream

Medicines and their possible side effects can affect people in different ways. The following are some of the side effects that may be associated with estriol cream.

• Vaginal irritation or itching after applying the cream.
• Vaginal discharge.
• Tell your doctor if you get any unusual vaginal bleeding or spotting.

You should read the patient information leaflet that is supplied with your medication for more information about side effects associated with Estriol cream.

Using other medicines with Estriol cream

• Estriol is only absorbed into the bloodstream in low amounts from the vagina, so it's unlikely to affect other medicines that you are taking, eg by mouth or injection. However, if you need to use any other vaginal medicines, for example pessaries or vaginal creams for thrush or other vaginal infections, your doctor may want you to stop using estriol cream during the treatment. Always check with your doctor.
• It's fine to use vaginal moisturisers or lubes alongside estriol vaginal cream.

References:

https://www.medicines.org.uk/emc/product/5384/smpc

http://www.hpra.ie/img/uploaded/swedocuments/23697ab8-b41f-469b-98db-e6560f9da5b3.pdf

https://www.medsafe.govt.nz/Consumers/cmi/o/ovestin-cream.pdf

https://www.medicines.ie/medicines/ovestin-1mg-per-gram-vaginal-cream-33264/patient-info

https://www.netdoctor.co.uk/medicines/a7950/ovestin-cream-estriol/

http://mcs.open.ac.uk/nlg/old_projects/pills/corpus/PIL/data/Organon/Ovestin_Cream/Ovestin_Cream.html

https://www.ncbi.nlm.nih.gov/pubmed/7141096