Description
How it works
After the menopause, natural oestrogen levels fall. This can lead to thinning and drying of the vaginal tissues, a higher vaginal pH, and increased risk of discomfort and infections.
Estradiol 10 micrograms vaginal tablets work by:
- Providing a very low dose of estradiol (a form of female sex hormone identical to the body’s own oestrogen) directly to the vagina
- Restoring and thickening the vaginal lining, helping it become more elastic and better lubricated
- Normalising vaginal pH, which supports healthy bacterial balance
- Reducing symptoms such as dryness, burning, itching, soreness and pain during intercourse
Because the tablets are used locally in the vagina, only small amounts of estradiol are absorbed into the bloodstream, and levels generally remain within the normal postmenopausal range. A separate progestogen is not usually needed with this low-dose vaginal treatment.
Who it may be suitable for
Estradiol 10 micrograms vaginal tablets are intended for:
- Postmenopausal women with symptoms of vaginal atrophy due to oestrogen deficiency, such as:
- Vaginal dryness, burning or itching
- Soreness or irritation of the vagina and vulva
- Pain or discomfort during sex (dyspareunia)
- Recurrent urogenital symptoms linked to vaginal atrophy
It is a local treatment for vaginal symptoms and is not designed to treat whole-body menopausal symptoms such as hot flushes or night sweats.
Who should not use Estradiol 10 micrograms vaginal tablets
Do not use this medicine if you:
- Have current, past or suspected breast cancer
- Have current, past or suspected oestrogen-dependent cancer (for example, endometrial cancer)
- Have unexplained vaginal bleeding that has not been investigated
- Have untreated endometrial hyperplasia (thickening of the womb lining)
- Have or have had a venous blood clot (deep vein thrombosis, pulmonary embolism)
- Have a known thrombophilic disorder (e.g. protein C, protein S or antithrombin deficiency)
- Have active or recent arterial thromboembolic disease such as angina or a heart attack
- Have acute liver disease, or a history of liver disease where liver tests are still abnormal
- Are allergic to estradiol or any of the tablet ingredients
- Have porphyria (a rare blood pigment disorder)
Estradiol 10 micrograms vaginal tablets are not indicated in pregnancy or during breastfeeding. Treatment should be stopped if pregnancy occurs.
Use with extra care / medical supervision
Extra monitoring may be needed if any of the following apply now or applied in the past:
- Uterine fibroids (leiomyoma) or endometriosis
- Risk factors for blood clots (e.g. significant obesity, prolonged immobility, major surgery, systemic lupus erythematosus, certain clotting disorders)
- Risk factors for oestrogen-dependent tumours (e.g. first-degree relative with breast cancer)
- High blood pressure
- Liver disorders, including benign liver tumours
- Diabetes, with or without blood vessel involvement
- Gallbladder disease
- Migraine or severe headache
- Systemic lupus erythematosus (SLE)
- Previous endometrial hyperplasia
- Epilepsy, asthma or otosclerosis
Treatment should be reviewed regularly (usually at least once a year) to ensure that the benefits continue to outweigh any risks, especially with long-term or repeated use.
Side Effects
Not everyone gets side effects. When they do occur, they are often mild and more likely during the first weeks of treatment.
Common side effects may include:
- Headache
- Abdominal pain or discomfort
- Nausea
- Vaginal bleeding or spotting
- Vaginal discharge or vaginal discomfort
- Vulvovaginal yeast (thrush) infection
- Rash or skin irritation
- Hot flushes
- Raised blood pressure
- Slight weight gain
The intravaginal applicator itself can occasionally cause minor local trauma, especially in women with severe vaginal atrophy.
Less common or rare side effects reported with low-dose vaginal oestrogen (often at very low frequency) include:
- Vaginal irritation, itching, pain, ulceration or vaginismus
- Endometrial hyperplasia (thickening of the womb lining)
- Fluid retention
- Worsening of migraine, insomnia
- Deep vein thrombosis (blood clot in the leg)
- Urticaria (hives), erythematous or itchy rash, genital itching
- Breast tenderness or breast changes
Although systemic absorption is low, some risks known from systemic hormone replacement therapy (HRT) – such as blood clots, stroke, ovarian cancer and breast cancer – may still be relevant in long-term or repeated use, but at a much lower level.
Serious side effects – seek urgent medical help
Stop using the tablets and seek urgent medical advice if you experience:
- Sudden chest pain, shortness of breath, coughing up blood
- Painful swelling, redness or warmth in one leg
- New severe headache or migraine-type headache
- Yellowing of the skin or eyes (jaundice), dark urine, severe abdominal pain
- New breast lump or significant breast changes
- Unexplained vaginal bleeding or persistent spotting after you have been on treatment for a while
- Signs of severe allergic reaction: sudden rash, itching, hives, swelling of the face, lips, tongue or throat, difficulty breathing or swallowing
Patient Information Leaflet
Please see HERE for the Patient Information Leaflet
Additional Info
Key points about Estradiol 10 micrograms vaginal tablets:
- Active ingredient: Estradiol hemihydrate equivalent to 10 micrograms estradiol per vaginal tablet
- Use: Local treatment of vaginal atrophy in postmenopausal women
- Form: Small white, round, film-coated vaginal tablets used with a reusable applicator
- Effect: Primarily local; systemic oestrogen levels generally stay within the postmenopausal range
- Endometrial protection: For this low-dose vaginal product, a progestogen is not usually added
- Endometrial safety: Long-term (over one year) or frequently repeated courses should be reviewed at least annually, especially in women with a womb (intact uterus)
- Driving and using machines: No known effect. If you feel unwell (e.g. headache), wait until symptoms settle before driving
Excipient information:
- Contains lactose – not suitable for women with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose–galactose malabsorption
- Also contains hypromellose, maize starch, magnesium stearate and macrogol
Interactions with other medicines:
- Due to minimal systemic absorption, clinically significant interactions with other medicines are unlikely
- Interactions with other locally applied vaginal treatments (e.g. other creams, pessaries) should be considered – avoid using multiple vaginal products at the same time unless advised
Estradiol 10 micrograms vaginal tablets are a prescription-only medicine and should be used under medical supervision, with regular reviews of benefit and risk.
Directions
Estradiol 10 micrograms vaginal tablets are for vaginal use only – they are not to be swallowed.
The tablets are supplied with a reusable applicator to help place the tablet high in the vagina.
Standard dosing schedule
- Initial treatment (loading phase):
- One vaginal tablet once daily for 2 weeks
- Maintenance treatment:
- Then one vaginal tablet twice a week (for example, Monday and Thursday), leaving 3–4 days between doses
Treatment can be started on any convenient day.
For ongoing treatment of postmenopausal symptoms, the lowest effective dose should be used for the shortest duration, with regular reviews.
Step-by-step insertion
- Wash your hands thoroughly.
- Remove the applicator from its packaging.
- Gently pull the plunger out until it stops.
- Remove one tablet from the blister and place it firmly in the holder at the wide end of the applicator.
- Adopt a comfortable position (lying on your back with knees slightly bent is common).
- Gently insert the applicator into the vagina until you feel resistance (usually about 8–10 cm).
- Slowly press the push-button / plunger until it stops – this releases the tablet onto the vaginal wall.
- Withdraw the applicator. The tablet will stick to the vaginal wall and should not fall out when you stand up or walk.
Cleaning the applicator
After each use:
- Pull the plunger out of the tube
- Wash both parts with mild soap and warm tap water, rinsing inside and out
- Shake off excess water if needed and allow to air dry on a clean surface
- Reassemble the applicator ready for next use
The applicator should be used for the entire treatment pack and then discarded.
Vaginal infections should be treated before starting estradiol vaginal therapy.
Missed a dose?
If you forget a dose:
- Take the missed tablet as soon as you remember
- Continue with the next dose at the usual time
- Do not use two tablets at the same time to make up for a missed dose
If you have missed several doses, or are unsure how to restart the schedule, seek advice from a healthcare professional.
FAQs
What are Estradiol 10 micrograms vaginal tablets used for?
Estradiol 10 micrograms vaginal tablets are used to treat postmenopausal symptoms of vaginal atrophy, including dryness, soreness, itching, and painful intercourse, by addressing local low oestrogen levels.
How long will it take before I feel an improvement?
Most women notice some relief within a few weeks, though full benefits can take 8 to 12 weeks to achieve, and these improvements are typically maintained with twice-weekly use.
Will this medicine help with hot flushes and night sweats?
No, this is a local treatment specifically for vaginal symptoms and does not provide systemic HRT, meaning it cannot treat hot flushes, night sweats, or mood-related symptoms.
Do I need to take a progestogen with it?
A progestogen is usually not required with this low-dose local oestrogen even if you have a womb, but any unexpected vaginal bleeding must still be investigated by a professional.
Is it safe if I’ve had breast cancer?
Women with a current, past, or suspected history of breast cancer or other oestrogen-dependent cancers should not use this medicine unless specifically advised and guided by a specialist.
What should I do if I notice vaginal bleeding while using it?
While light spotting may occur at the start of treatment, you should not ignore any unexpected bleeding or spotting, especially after long-term use, and must have it checked by a doctor.
Can I use lubricants or other vaginal products at the same time?
Water-based lubricants can be used as needed, but you should avoid other vaginal treatments simultaneously unless approved by a professional to ensure they do not interfere with the efficacy of the estradiol tablets.
Can I use this medicine if I’m still having periods?
No, these tablets are strictly for postmenopausal women with oestrogen deficiency, so if you are still having periods or are unsure of your menopausal status, you must be assessed by a clinician first.
Do I need regular check-ups while using it?
Yes, you require at least one clinical review per year to reassess your symptoms and general health, including appropriate examinations, to decide if treatment should continue, be adjusted, or stop.
When should I stop treatment and seek urgent help?
You must stop treatment and seek urgent help from 24 HR Pharmacy or emergency services for symptoms like chest pain, breathlessness, jaundice, new severe migraines, new breast lumps, or unexplained vaginal bleeding.
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