Vaginal estrogen is one of the lowest risk forms of HRT. You can use it as an alternative to systemic HRT or as a complement. Take a look at this article to find out more about it and how it can be used.
What causes the vaginal area to change during menopause?
As estrogen levels fall, the skin around the vagina and urethra (tube that drains urine from the bladder outside) become thinner. This is called vulvovaginal atrophy. Reduced estrogen may also cause changes in the acidity and vaginal lubrication. Sex can be painful and the internal skin may become sore.
Reduced estrogen levels and thinning of the tissues around the urethra and vagina can lead to more frequent infections. You should consult your healthcare provider if you notice an increase in urinary frequency or pain in the passing of urine. A urine sample that contains blood should be tested for abnormalities. Urinary problems should not be ignored. Although they can be hard to talk about, it is better to address them immediately.
Local estrogen can be used to treat symptoms of menopausal vaginal atrophy. If the symptoms are severe, this can be used in conjunction with full HRT.
When to use Vaginal Estrogen HRT and how it should be used
Vaginal estrogen works in the local area, i.e. around the vagina. It is very safe as it is not absorbed into other parts of the body. It can reduce the symptoms of your vaginal problems, such as dryness and painful sex.
Contrary to full systemic HRT, progesterone does not need to be used as well. Because the estrogen dose is low, it is unlikely to stimulate the growth of the endometrium (womb line).
Different types of Vaginal Estrogen HRT
In medical terms, the different forms of Vaginal Estrogen are sometimes called 'preparations'. If you are experiencing symptoms, there are many preparations of Vaginal Estrogen that you can choose from.
Creams - Inserted with a plunger and a cup with a very small size. Use nightly for two weeks, then reduce to once a week. Although the cream is quick to work, it can get messy.
Pessary is a pill shaped like a bullet that you place into your vagina. It then dissolves. The dosage is twice per week for two weeks. After that, it can be used daily. It may cause a slightly chalky discharge the next morning.
Rings - may be placed by a healthcare professional and left for up 3 months before being changed. Estrogen will slowly be released to replace what has been lost.
Gel - A gel that is similar to a cream and can be used in the exact same way
What is the role of vaginal estrogen?
Locally absorbed vaginal estrogen improves skin quality and thickness, returns vaginal acidity to normal, and improves lubrication.
Is it safe?
Yes, it is safe. Vaginal estrogen absorbs very little estrogen into the bloodstream. The dose used is equivalent to taking just one 1mg Estrogen oral tablet a year. They function in the same way as a hand cream or face cream. If necessary, they can be combined with vaginal moisturisers or lubricants.
Women who have experienced vaginal symptoms or have had a history of breast cancer may still consider this option. However, it should be discussed with your doctor individually. Vaginal estrogen can interact with breast cancer medication for women who are currently being treated.
Side effects: Some women may experience slight breast tenderness and bloating in the first two weeks, but these symptoms quickly disappear. You can continue to take intermittent treatments as necessary for the long-term. It is possible to use vaginal estrogen several weeks before a cervical test to make it more comfortable. However, don't use it on the night before.
Always read the leaflet for any medication you are given. All side effects that may occur with any Estrogen type will be listed in this information. These side effects are rare because the vaginal estrogen dose is so low.
When you first start a medication, it is important to keep track of your side effects and monitor them. Any bleeding or other symptoms that occur while using vaginal estrogen should be reported immediately to your doctor.
Read more about the different ways to take HRT here.