7.2.1 Preparations for vaginal and vulval changes
| Choice | Drug |
|---|
| 1st choice | Estriol 0.1% intravaginal cream |
| 2nd choice | Estradiol 10microgram pessaries |
| |
Prescribing Notes
- Topical vaginal oestrogen may be used for the treatment of menopausal atrophic vaginitis; systemic therapy is necessary for vasomotor symptoms.
- Compared to systemic HRT, minimal amounts of vaginal oestrogen are absorbed into the bloodstream. Serious adverse effects are very rare.
- For use in people with a personal history of breast cancer see NICE NG23.
- Treatment should be reviewed at at 3 months to assess efficacy and tolerability, and annually thereafter, unless there are clinical indications for an earlier review.
- 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; but treatment can be restarted if necessary; there is no fixed duration of use and each woman should be assessed individually.
- Estradiol pessaries may be useful in women who find creams difficult or messy to use. They are more expensive than estriol 0.1% cream.
- Vaginal creams may damage latex condoms and diaphragms.
- An impregnated vaginal ring (Estring®) is also available. It is left in place for 3 months.
