Vaginal oestrogen is available as a pessary (vaginal tablet) or cream under the brand names Vagifem-low and Ovestin (Cream and Ovula)
Vaginal oestrogen is usually used after menopause for symptoms of vaginal dryness causing discomfort and painful sex and also for bladder irritability, cystitis and incontinence. It is sometimes used in perimenopausal women with similar symptoms. It can be used in conjunction with oestrogen tablets, patches or skin gel.
You do not require additional progesterone if you are using vaginal oestrogen even if you have a uterus.
Vaginal oestrogen is also used in the weeks prior to gynaecological surgery or taking a cervical smear in women who have vaginal dryness to make the procedure more comfortable.
Vagifem-low
Vagifem is a pessary (vaginal tablet) applied directly to the vagina. It contains estradiol which is a hormone which is the same as your own body makes (body-identical). It acts directly on vaginal tissues with some local absorption from the urethra bladder and pelvic floor.
What’s in the box?
Each pessary contains oestradiol 10 mcg and inactive ingredients.
There are 18 pessaries and single use applicators in each box lasting 9 weeks with stable, typical use.
How to use Vagifem
Vagifem comes as a vaginal tablet in a single use disposable applicator.
It is inserted into the vagina, sticking to the vaginal wall where it releases its estradiol slowly. It is preferable to use it at night and you may need to use some water on the applicator until the vaginal dryness settles.
Generally one dose is applied into the vagina every night for 2-3 weeks and then ongoing only twice a week.
Your doctor may ask you to use Vagifem differently depending on your symptoms. Some females find this dosage inadequate (and need more) or hard to remember (using the Vagifem every night for the first week of the month, then not again until the next month may be easier).
You will probably see a response in a couple of weeks but you may also need to change doses and treatments. Vaginal spotting can sometimes occur with Vagifem.
Ovestin
Ovestin is a cream or pessary applied directly to the vagina. It contains estriol which is one of your body’s body identical hormones, mostly produced during pregnancy. It acts directly on vaginal tissues with some local absorption from the urethra bladder and pelvic floor.
What’s in the box?
Ovestin cream
Cream contains oestriol and inactive ingredients.
0.5mg oestriol per 0.5g dose of cream.
Each tube is 15g, making 30 doses – 15 weeks at stable regular use.
Ovestin Ovula
Each pessary contains oestriol and inactive ingredients.
0.5mg oestriol per pessary.
There are 15 pessaries in a box – 7 weeks at stable regular use.
How to use Ovestin
Apply the cream toward the front wall of the vagina but not as deep as you would insert a tampon. This is because the urethra sits lower in the vagina wall and benefits from being close to the Ovestin cream. Wash out the applicator with warm soapy water after you use it.
Your doctor may also ask you to apply it to the skin of your vulva for dryness or itchiness.
Ovestin Ovula is a pessary or tablet that is inserted into your vagina. You may need to use a little water to help until the vaginal dryness settles after a couple of weeks.
Generally one dose is applied into the vagina every night for three weeks and then twice a week depending on your response.
Your doctor may ask you to use Ovestin differently depending on your symptoms.
It is common to have to adjust your dosage according to your response. It takes a few months to settle into your right dose and you may also need to change doses and treatments as you journey through menopause. Vaginal spotting can sometimes occur with Ovestin.
Risks of using vaginal (local) oestrogen
Reasons not to start Vagifem or Ovestin
Allergies to Vagifem or Ovestin
Unexplained vaginal bleeding
Unexplained vulval skin lesions
Severe liver disease
You are pregnant
Speak with your doctor about any risks because you have…
Blood clots
Cancer
Migraines
Side effects of vaginal oestrogen
Side effects are uncommon and you may not experience any. Most are not serious and will settle over a few months.
Local irritation or itching, increased vaginal discharge, thrush.
Stop taking vaginal oestrogen and seek medical advice if…
Migraines are getting worse
The skin or eyes are becoming yellow
Any significant increase in vaginal bleeding
You think you have thrush
