Vaginal atrophy
Topical oestrogens – Estriol cream.
Apply 1 applicatorful daily for 3-4 weeks (by vagina), then reduced to 1 applicatorful twice weekly, to be applied at bedtime, treatment should be evaluated after 12 weeks.
Most of the available generic estradiol pessaries come with a reusable applicator. For those with dexterity issues requiring a pre-filled applicator specify the product to be supplied on the prescription e.g. Estradiol 10microgram pessaries Sun Pharma UK Ltd or Vagifem. Select the product with the lowest acquisition cost.
Insert 1 tablet daily into the vagina, for two weeks, then reduced to 1 tablet twice weekly.
Estring.
Replace 3monthly, maximum duration of treatment is 2 years.
Prescribing Notes:
- Local oestrogen treatment can improve vaginal and bladder symptoms caused by menopause; systemic therapy is necessary for vasomotor symptoms.
- Estradiol vaginal tablets may be useful in women who find creams difficult or messy to use.
- Women using long-term vaginal oestrogen treatments do not need to add in cyclical progestogen therapy.
- Most women with significant vulvo-vaginal atrophy will require long-term treatment particularly if sexually active.
- Symptoms recur when local vaginal oestrogens are discontinued; there is no fixed duration of use and each woman should be assessed individually.
- The lowest effective dose should be used for shortest duration possible.
- Some intravaginal creams contain arachis (peanut) oil and are therefore not suitable for patients with peanut allergy. For patients with peanut allergy select a formulation without arachis oil and specify the manufacturer and/or brand name on the prescription. Full details of the excipients can be found in the manufacturers Summary of Product Characteristics at www.medicines.org.uk or MHRA Products | Home.
- Vaginal creams may damage latex condoms and diaphragms.
History Notes
29/05/2025
Updates to prescribing information, ERWG May 25.
02/07/2024
Change to generic estriol 1mg/g vaginal cream, prescribing information updated.
18/05/2022
East Region Formulary content agreed.