| Choice | Drug | Dosage |
|---|---|---|
| 1st choice | Estriol 0.1% intravaginal cream (Ovestin®1mg cream) | Dose: vaginal surgery, 1 applicator dose daily for two weeks before surgery, resuming 2 weeks after surgery using 1 applicator dose twice a week |
| 2nd choice | Estradiol 10 micrograms vaginal tablets (Vagifem®) | Dose: Insert one vaginal tablet daily for 2 weeks then reduce to one tablet twice weekly |
Prescribing Notes
- Topical vaginal oestrogen may be used on a short term basis for the treatment of menopausal atrophic vaginitis; systemic therapy is necessary for vasomotor symptoms.
- It is important to bear in mind that topical oestrogens should be used in the smallest effective amount to minimise systemic effects.
- The risk of endometrial hyperplasia and carcinoma is increased when systemic oestrogens are administered alone for prolonged periods. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain. If symptoms of atrophy settle with use, treatment is usually continued at a low maintenance dose of 1-2 times weekly. However, treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.
- 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; there is no fixed duration of use and each woman should be assessed individually.
- Vagifem® may be useful in women who find creams difficult or messy to use. It is more expensive than Ovestin.®
- Vaginal creams may damage latex condoms and diaphragms.
- An impregnated vaginal ring (Estring®) is also available. It is left in place for 3 months.