Description
How it works
After the menopause, falling oestrogen levels cause the vaginal and vulval tissues to become thin, dry and fragile. This can lead to:
- Vaginal dryness and burning
- Itching of the vulva (pruritus vulvae)
- Painful sex (dyspareunia)
- Recurrent irritation or discomfort around the vagina
Estriol is a natural oestrogen. When applied directly inside the vagina, it:
- Helps restore the thickness and elasticity of the vaginal lining
- Increases natural lubrication, easing dryness and discomfort
- Reduces itching, soreness and painful sex linked to atrophic vaginitis
The cream acts locally, with very low levels of estriol entering the bloodstream. At the low dose used, it mainly treats local vaginal symptoms rather than general menopausal symptoms (like hot flushes).
Who it may be suitable for
Estriol 0.01% Vaginal Cream is intended for postmenopausal women with:
- Atrophic vaginitis (thinning and dryness of the vaginal lining)
- Kraurosis vulvae (thinning and shrinkage of the vulval skin)
- Pruritus vulvae (itching) caused by lack of oestrogen
- Dyspareunia (pain during sex) due to atrophic vaginal epithelium
It is particularly useful if symptoms are mainly vaginal/vulval rather than whole-body menopausal symptoms.
Because the dose is low and the effect largely local, no additional progestogen is usually needed, even if you still have a womb – but long-term or repeated use should still be reviewed regularly.
Who should not use it
Do not use Estriol Vaginal Cream if you:
- Are allergic to estriol or any ingredient in the cream
- Are allergic to peanuts or soya – the cream contains arachis (peanut) oil, and patients with peanut or soya allergy must avoid it
- Have current, past or suspected breast cancer
- Have or are suspected of having an oestrogen-dependent cancer (e.g. womb cancer)
- Have unexplained vaginal bleeding
- Have untreated endometrial hyperplasia (thickened womb lining)
- Have ever had a venous blood clot (deep vein thrombosis or pulmonary embolism)
- Have a known thrombophilic disorder (e.g. protein C, protein S, or antithrombin deficiency)
- Have active or recent arterial thromboembolic disease (e.g. angina, heart attack)
- Have acute liver disease, or a history of liver disease with abnormal liver tests
- Have porphyria
It is not indicated during pregnancy or breastfeeding. If you become pregnant while using it, treatment should be stopped.
Use with extra care / monitoring
You may still be able to use this cream, but will need closer monitoring, if you have or have had:
- Uterine fibroids or endometriosis
- Risk factors for blood clots (overweight, major surgery, prolonged immobility, strong family history, systemic lupus erythematosus, cancer)
- Strong family history of breast cancer
- High blood pressure
- Liver problems, including liver adenoma
- Diabetes, with or without blood vessel involvement
- Gallstones
- Migraine or severe headaches
- Systemic lupus erythematosus (SLE)
- Previous endometrial hyperplasia
- Epilepsy, asthma or otosclerosis
The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain, so treatment should be reviewed at least once a year, and any new vaginal bleeding should be investigated.
Side Effects
In clinical trials, this cream was generally well tolerated. In a controlled study, the following side effects were reported more often in women using estriol compared with placebo:
- Breast pain or tenderness
- Vaginal discharge
- Increased frequency of passing urine
- Cystitis or urinary discomfort
- Lower abdominal pain or pelvic discomfort
- Leg pain
- Premenstrual-type tension
- Palpitations (awareness of heartbeat)
- Low mood or depression
These are usually mild and temporary.
Because estriol is an oestrogen, class effects of hormone replacement therapy may also apply, especially with long-term or repeated use, although the risk is lower with low-dose local vaginal preparations:
- Slightly increased risk of endometrial hyperplasia and endometrial cancer in women with a womb if oestrogen is used alone for long periods
- Slightly increased risk of ovarian cancer with long-term HRT use
- Increased risk of venous thromboembolism (blood clots in the legs or lungs) with systemic HRT (applies to a lesser extent for low-dose vaginal oestrogen but must still be considered)
Stop using the cream and seek urgent medical help if you notice:
- Painful swelling, redness or warmth in one leg
- Sudden chest pain, breathlessness, or coughing up blood
- Sudden severe headache or migraine with visual or speech problems
- Yellowing of the skin or eyes (jaundice), or severe itching
- A new breast lump
- New, persistent or heavy vaginal bleeding, especially after being period-free for some time
Any persistent, troublesome or unusual symptoms should be checked by a healthcare professional.
Patient Information Leaflet
Please see HERE for the Patient Information Leaflet
Additional Info
Key points about Estriol 0.01% Vaginal Cream:
- Type of medicine: Low-dose vaginal oestrogen preparation
- Active ingredient: Estriol 0.01% w/w (0.5 mg per 5 ml applicator)
- Form: Whitish vaginal cream supplied in a tube with an applicator
- Main uses:
- Atrophic vaginitis and vulval atrophy in postmenopausal women
- Pruritus vulvae and dyspareunia associated with oestrogen deficiency
- Progestogen: Not routinely required at this low, local dose, but long-term or repeated use should be reviewed regularly, especially in women with a womb
- Allergy warning: Contains arachis (peanut) oil and benzoic acid (which can cause mild irritation) – do not use if you are allergic to peanuts or soya
- Interactions:
- Medicines that induce liver enzymes (e.g. certain epilepsy medicines, rifampicin, nevirapine, efavirenz, bosentan, and St John’s wort) can increase oestrogen metabolism, which may alter bleeding patterns, though the effect is less marked with vaginal use.
- May reduce lamotrigine levels (as with other oestrogen therapies), potentially lowering seizure control – monitoring and dose adjustment of lamotrigine may be needed.
- Barrier methods: The cream can damage rubber (latex) contraceptive diaphragms and condoms, so do not rely on these as contraception while using it.
- Driving and machinery: No known effect on the ability to drive or use machines.
Regular check-ups, including pelvic and breast examinations as advised, are recommended during treatment.
Directions
Estriol 0.01% Vaginal Cream is for vaginal use only. It must not be taken by mouth.
Each full applicator (5 ml) contains 0.5 mg estriol.
Usual dosing
- Starting dose (initial treatment):
- One full applicator (5 ml) once daily, applied into the vagina, usually in the evening, until symptoms improve and the vaginal lining has recovered (your prescriber will advise typical duration).
- Maintenance dose:
- Once symptoms are controlled and the vaginal mucosa is restored, a maintenance dose of one applicator full twice a week (e.g. Monday and Thursday evenings) may be used.
For menopausal symptoms generally, the aim is always to use the lowest effective dose for the shortest time, with attempts to pause or stop treatment every 3–6 months under medical review.
How to apply the cream
- Prepare the tube and applicator
- Remove the cap from a new tube.
- Use the pointed top of the cap to pierce the metal seal on the tube.
- Make sure the plunger is fully pushed in to the applicator barrel.
- Screw the open end of the applicator firmly onto the tube.
- Fill the applicator
- Squeeze the tube gently so that the barrel fills with cream up to the marked level (one full applicator = 5 ml).
- Unscrew the applicator and replace the cap on the tube.
- Insert the cream
- Lie on your back with knees bent and slightly apart.
- Gently insert the open end of the applicator high into the vagina.
- Push the plunger firmly but gently all the way in to empty the cream.
- While keeping the plunger pressed, withdraw the applicator.
- After use
- Clean the applicator as instructed in the patient leaflet (if reusable) or dispose of it if it is a single-use design (depending on pack instructions).
- Using the cream in the evening before bed helps keep it in place and reduces leakage.
There is no relevant use in children.
Missed a dose?
If you forget to apply a dose:
- Simply resume your usual schedule as soon as you remember.
- Do not apply extra cream to make up for a missed dose.
Occasional missed doses are unlikely to cause problems, but frequent omissions may reduce symptom control.
FAQs
What is Estriol Vaginal Cream used for?
Estriol Vaginal Cream is a local treatment used to relieve postmenopausal vaginal and vulval symptoms like dryness, soreness, itching, and painful intercourse caused by oestrogen deficiency, rather than treating systemic symptoms like hot flushes.
Do I need to take a progestogen with this cream?
A progestogen is not routinely required at this low local dose even if you have a womb, but due to uncertain long-term safety data, you must have annual reviews and any new vaginal bleeding must be investigated.
How long will I need to use it?
You typically start with daily use before moving to a twice-weekly maintenance schedule, and while many women require ongoing treatment, a doctor will normally review your progress every 3 to 6 months to determine if treatment can be adjusted.
Can I use it with condoms or a diaphragm?
No, the oils in the cream can weaken latex and make condoms or diaphragms less effective, so you should use non-latex or other non-hormonal contraceptive methods recommended by your clinician.
Is this cream absorbed into my bloodstream?
While intended for local action, some estriol is absorbed into the blood, but levels usually remain within the normal postmenopausal range; however, standard HRT monitoring and cautions still apply for long-term or repeated use.
What if I still have pain or bleeding after a few weeks?
If your symptoms persist or if you develop new vaginal bleeding or worsening pain, you should contact a doctor for a review as these issues may require further investigation or a change in your treatment plan.
Can I use this cream if I have a peanut or nut allergy?
No, because this cream contains peanut oil, women with a peanut or soya allergy must not use it and should seek an alternative preparation from their 24 HR Pharmacy provider.
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