Estriol Cream

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What is Estriol Cream?

Estriol cream is a topical treatment prescribed to relieve the vulvovaginal symptoms of menopause, including vaginal dryness, inflammation or itching, discomfort or pain during sex, vaginal tightness, spotting. It is sold under the brand names Ovestin and Gynest.

How does Estriol Cream Work?

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).

Estriol Cream Summary

Estriol Cream Ingredients

Active Ingredients

The active ingredient in estriol cream is estriol 1mg/1g.

Inactive Ingredients

The inactive ingredients in estriol cream are octyldodecanol, cetyl palmitate, glycerin, cetyl alcohol, stearyl alcohol, polysorbate 60, sorbitan stearate, chlorhexidine dihydrochloride, lactic acid, sodium hydroxide to pH 4 and purified water.

Estriol Cream Dosage

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 estriol 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 (0.5g) twice per week at the same times each week.

Starting Estriol Cream

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.

How to use 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 bedsheets 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 have 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.

Estriol Side Effects

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:

• Migraine-like headaches 
• Yellowing of the skin or whites of the eyes (jaundice)
• A rise in blood pressure
• Signs of a severe allergic reaction, including swelling, irritation or rash at the area of applications
• 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
• Gallbladder problems
• Rash or hypersensitivity to sunlight
• Swelling or tender breasts
• Headaches
• Nausea or vomiting
• Flu-like symptoms

For more information on possible side effects, please read the Patient Information Leaflet.

Contraindications

Do NOT use estriol cream if you:

• Are allergic to estriol or to any of the other ingredients in this treatment
• Have had angina or a heart attack (myocardial infarction)
• Have had a blood clot (thrombosis)
• Have had breast cancer or suspect that you have breast cancer
• Have had cancer of the sex organs, such as endometrial cancer or ovarian cancer
• Have unexplained vaginal bleeding
• Have excessive thickening of the womb lining (endometrial hyperplasia) 
• Have had liver disease, or your liver is not working properly
• 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 the growth of the womb lining outside of the womb (fibroids or endometriosis)
• Problems with your heart or circulation
• A family history of blood clots
• Asthma
• Diabetes
• Migraines or severe headaches
• Epilepsy
• Gallstones
• Liver or kidney problems
• Systemic lupus erythematosus (SLE)
• A hearing disorder known as otosclerosis

Drug Interactions

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
• Regimens for hepatitis C e.g. ombitasvir, paritaprevir, ritonavir, dasabuvir

Pregnancy and Breastfeeding

Do NOT use estriol cream if you are breastfeeding, pregnant, might be pregnant, or are planning on becoming pregnant.

Treatment Options

HRT

Hormone replacement therapies (HRTs) are the most effective treatment for the symptoms of menopause. Topical creams such as estriol or Ovestin 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 fewer side effects. It is also of note that both estriol cream and Vagifem 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 a Mirena coil), or a combination of oestrogen and progestogen 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 that 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.

If you have an intact womb, you will be more suited to a combined formulation that contains both oestrogen and progestogen such as Elleste Duet, Trisequens or Evorel Sequi (if you’ve had a period within the last 12 months) or Elleste Duet Conti, Kliovance or Evorel Conti (if you’ve not had a period in the last 12 months).
 

Alternatives to HRT

While HRT is the most accessible and effective treatment for the symptoms of menopause and can be accessed online through 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 a herbal product, speak to a doctor or pharmacist about its ingredients and effectiveness. Some women also choose not to take any specific treatment, particularly if symptoms are mild or if they have risk factors that prohibit the use of HRT.

Lifestyle changes to improve menopause symptoms

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.

FAQ

How effective is estriol cream?

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 HRT. For many women, topical creams are the first step when starting HRT. It’s worth noting that estriol cream will NOT treat symptoms like hot flushes, night sweats or mood changes.

Is estriol cream safe?

Estriol cream is considered safe for use in most women, although it is important to check contraindications and drug interactions before use. Oral HRT  is thought to slightly increase the risk of breast cancer, ovarian cancer, blood clots and stroke. However, the benefits of HRT often far outweigh the risks. Topical HRTs such as estriol cream carry fewer risks and are not thought to be associated with an increased risk of cancer or blood clots. The hormone estriol itself is bioidentical, meaning it is exactly the same as one of the 3 principle oestrogens produced naturally by the body. It is the least potent of the three, which despite not limiting its effectiveness in relieving menopause symptoms, is thought to make it safer in terms of health complications.

How long does estriol cream take to work?

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 the application to twice per week for as long as is needed.

Will I need to use estriol cream for the rest of my life?
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.

Does estriol cream cause weight gain?

There is no evidence to suggest that weight gain is a side effect of estriol cream.

Can I use estriol cream before an operation?

If you are planning on undergoing surgery, tell your doctor in advance that you are using estriol cream. 

What happens during the menopause?

The menopause occurs when a woman permanently stops having her period. Around this time hormone levels of oestrogen and progesterone decrease and can cause menopausal symptoms such as changes to periods, hot flushes, night sweats, mood changes and vaginal dryness.  

Menopausal symptoms can begin months or years before the final period and symptoms can persist for years afterwards.

What is the menopause age?

For most women, the menopause begins between the ages of 45 and 55. The mean age of the natural menopause in the UK is 51. If the menopause begins before the age of 45, it is classed as early menopause.

What are the side effects of HRT?

Side effects can differ between different HRT medicines but some common side effects of HRT include:

• Breast pain or tenderness
• Headaches
• Vaginal bleeding
• Nausea
• Stomach pain

HRT can have rare, serious side effects such as increasing the risk of certain cancers. Further information can be found here.

Do you gain weight on HRT?

Research has shown that women can gain weight during the menopause. However, the manufacturers of some HRT products do list weight gain as a side effect of treatment. This can be a common side effect of some products and an uncommon side effect of others.

How long does it take for hormone therapy to work?

The full effects of HRT can take up to three months to show but some women may notice benefits within a few weeks of starting therapy.

How does a woman feel during menopause? 

The menopause can be accompanied by symptoms that affect a woman’s quality of life. The physical symptoms like hot flushes and night sweats can cause psychological distress. Other symptoms can occur such as low mood, anxiety, and irritability. The menopause matters website offers information and support for women affected by the menopause.

What is the best HRT to take?

The type of HRT a patient should take depends on a number of factors, and the best HRT for one patient may not be the best for another patient. You should have a discussion with your doctor to decide whether HRT is suitable for you and which type of HRT is best to take. 

How long do HRT side effects last?

Some of the common side effects of HRT like nausea, headaches and breast pain should improve within the first 3 months of treatment. If these side effects are severe or persist after 3 months you should stop HRT and discuss with your doctor.