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Estriol cream is a topical treatment prescribed to relieve the symptoms of menopause, including vaginal dryness, inflammation or itching, discomfort or pain during sex, vaginal tightness, spotting, painful urination, and recurrent urinary tract infection (UTI). It is sold under the brand names Ovestin and Gynest.
Estriol Cream is a type of hormone replacement therapy (HRT) and contains estriol, a natural form of the hormone oestrogen produced by the body. When women reach menopause, the level of oestrogen produced by their ovaries decreases, leading to symptoms such as hot flushes and night sweats, mood swings, irregular periods, and vaginal dryness. Estriol Cream works locally by supplementing the hormone oestrogen in the vaginal area, reducing vaginal dryness and discomfort and reducing the likelihood of experiencing regular urinary tract infections (UTIs).
The active ingredient in Estriol Cream is estriol (0.01%).
The inactive ingredients in Estriol Cream are chlorhexidine dihydrochloride, octyldodecanol, cetyl palmitate, glycerin, cetyl alcohol, stearyl alcohol, polysorbate 60, sorbitan stearate, lactic acid, sodium hydroxide and purified water.
Your doctor will prescribe the lowest dose of Estriol Cream possible for your symptoms, and may wish to check in regularly to monitor your dosage. The usual dosage of Estradiol Cream is 1 full applicator (0.5g) each day for the first 2 to 3 weeks. After this time, lower your dose to 1 full applicator (0.05g) twice per week at the same times each week.
If you have had a hysterectomy, have never used HRT before, or are moving over from a period-free HRT, you can start using Estriol Cream at any time. However, if you are moving over from a form of HRT that allows for a monthly bleed, you will need to wait for a week after finishing your previous HRT before starting Estriol Cream.
Always use Estriol Cream as instructed by your doctor. It is best to use Estriol Cream before going to bed at night, as you will need to insert a full applicator of cream into the vagina. Unscrew the cap from the tube of cream and turn the cap over. Use the sharp point on the top of the cap to pierce the covering of the tube opening. Screw the end of the applicator onto the opening of the tube and squeeze the tube to fill the applicator up to the red line. The plunger will stop when the applicator is full. Unscrew the applicator and replace the cap onto the tube. Lie on your back and place the end of the applicator as deep into your vagina as possible, then slowly push the plunger all the way down to release the cream. Once you have carefully removed the applicator, keeping the plunger firmly pressed down as you do so, remove the plunger from the barrel and wash both parts in warm, soapy water. You may wish to use a sanitary towel overnight to protect your underwear and bed sheets from stains.
If you miss a dose of Estriol Cream, apply the dose as soon as possible within 12 hours of the original time. If 12 hours has already passed, skip the dose and apply your next one at the normal time. Never apply a double dose to make up for a missed one.
Like all medicines, Estriol Cream can cause side effects in some patients. If you experience any of the following side effects, stop using Estriol Cream and consult your doctor immediately:
Signs of a severe allergic reaction, including swelling, irritation or rash at the area of applications
A rise in blood pressure
Yellowing of the skin or whites of the eyes (jaundice)
Signs of a blood clot, including swelling of the leg or legs, sudden chest pain, or difficulty breathing
Other side effects are usually harmless, but you should inform your doctor if they affect you. These include:
Irritation or itching of the skin around the vagina, which usually gets better within a few weeks
Increase in vaginal discharge
Bleeding or spotting
Rash or hypersensitivity to sunlight
Swelling or tender breasts
Nausea or vomiting
Do NOT use Estriol Cream if:
You are allergic to estriol or to any of the other ingredients in this treatment
You have had angina or a heart attack (myocardial infarction)
You have had a blood clot (thrombosis)
You have had breast cancer or suspect that you have breast cancer
You have had cancer of the sex organs, such as endometrial cancer or ovarian cancer
You have unexplained vaginal bleeding
You have excessive thickening of the womb lining (endometrial hyperplasia)
You have had a liver disease, or your liver is not working properly
You have a rare blood problem known as porphyria
Tell your doctor and take particular care with Estriol Cream if you have or have ever had:
Problems caused by growth of the womb lining outside of the womb (fibroids or endometriosis)
Problems with your heart or circulation
A family history of blood clots
Migraines or severe headaches
Liver or kidney problems
Systemic lupus erythematosus (SLE)
A hearing disorder known as otosclerosis
Before using Estriol Cream, tell your doctor or pharmacist if you are taking or have recently taken any other medications, including those purchased over the counter without a prescription. In particular, inform your doctor if you are taking or have recently taken any of the following:
Medicines for epilepsy, including barbiturates, hydantoins and carbamazepine
Medicines for infection, including griseofulvin and rifamycins
Medicines for viral infections, including nevirapine, efavirenz, ritonavir, or nelfinavir
Herbal preparations including St John’s wort
Corticosteroids, succinylcholine, theophyllines, or troleandomycin
Regimen ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, for Hepatitis C
Do NOT use Estriol Cream if you are breastfeeding, pregnant, might be pregnant, or are planning on becoming pregnant.
Hormone replacement therapies (HRTs) are the most effective treatment for the symptoms of menopause. Topical creams such as Estriol (Ovestin) Cream and Premarin Cream, and vaginal suppositories such as Vagifem are only effective in relieving symptoms local to the vaginal area, but for this reason tend to have less side effects. It is also of note that both Estriol Cream and Premarin Cream can have a weakening effect on latex condoms, so you should speak to your doctor about alternative forms of contraception while using either.
Other HRTs come in the form of tablets and patches and can contain an oestrogen supplement only (suitable for women who have had a hysterectomy or who have an IUD, or mirena coil, fitted), or a combination of oestrogen and progesterone supplements. Premarin and Elleste Solo are oestrogen only forms of HRT that can be taken orally as tablets, while Elleste Solo MX80, Elleste Solo MX40 and Evorel are transdermal patches which are changed twice each week. The benefit of patches is that the oestrogen supplement bypasses the digestive system, which tends to reduce the likelihood of side effects.
While HRT is the most accessible and effective treatment for the symptoms of menopause, and can be accessed on prescription through the NHS and online at Dr Felix, some women choose to try herbal supplements instead. Some herbal remedies are thought to relieve symptoms such as mood swings and hot flushes, but their effectiveness is unknown. Before trying an herbal product, speak to a doctor or pharmacist about its ingredients and effectiveness.
The symptoms of menopause can to some extent be managed by making a few simple lifestyle changes. The impact of hot flushes can be reduced by cutting down on caffeine, alcohol and spicy foods, and by quitting smoking if you haven’t already done so. Exercise regularly and increase your intake of Vitamin D, which is vital in the production of calcium, to help keep your bones strong and healthy. While there is some suggestion that a diet rich in plant-based foods containing phytoestrogens can help to increase oestrogen levels, there is little evidence to suggest that this is an effective means of reducing menopause symptoms. Nevertheless, if you wish to try an oestrogen-rich diet, try increasing your intake of sesame and flaxseed, nuts, dried fruits, and other fruits such as oranges, strawberries and apricots.
Estriol Cream is considered an effective treatment for women who are struggling with vaginal symptoms of menopause, but do not want to start using oral or transdermal HRTs. For many women, topical creams are the first step when starting HRT.
Estriol Cream is considered safe for use in most women, although it is important to check contraindications and drug interactions before use. HRT in general is thought to slightly increase the risk of breast cancer by 1 to 5 cases in 1,000 dependent on age, and has been linked to a very slight increase in the risk of ovarian cancer, blood clots and stroke. This increase in risk is so slight that, for most women, the benefits of HRT far outweigh the risks, but be sure to check the patient information leaflet for additional information. Topical HRTs such as Estriol Cream carry less risks and side effects than other forms, as they work locally in the vaginal region and are not digested. The hormone estriol itself is a bioidentical, one of the 3 principle oestrogens produced naturally by the body. It is the least potent of the three, which despite not limiting its effect in relieving menopause symptoms, is though to make it safer in terms of health complications.
Estriol Cream usually begins to work within 2 to 3 weeks, during which time you will need to use the cream daily. Your doctor will then instruct you to reduce application to twice per week for as long as is needed.
The effects of Estriol Cream wear off soon after you stop using it, and many women continue to use it long-term. However, you may choose to switch to an alternative form of HRT that targets mood swings, hot flushes and other symptoms as well as vaginal symptoms, or you may choose to come off HRT altogether.
There is no evidence to suggest that weight gain is a side effect of Estriol Cream.
If you are planning on undergoing surgery, tell your doctor in advance that you are using Estriol Cream. They may tell you to stop using HRT 4 to 6 weeks in advance of your procedure in order to reduce the risk of blood clots.
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