Vaginal estrogen is a form of
estrogen that is delivered by
intravaginal administration. Vaginally administered estrogens are thereby exerting their effects mainly in the nearby tissue, with more limited
systemic effects compared to
orally administered estrogens.[1] It will not protect against osteoporosis.[2] With perhaps the exception of the
Femring,[3] it also will not alleviate the
hot flashes and hormonal imbalance caused by menopause.[2]
Indications
Vaginally administered estrogen are usually used to treat some menopausal symptoms that are isolated to the
vagina,
vulva and
urethra.[4]
Atrophic vaginitis, with presentations such as dryness and soreness in the vagina and
dyspareunia (pain during sexual intercourse)[1]
Urinary urgency (feeling an urge to urinate more often than is needed), or
dysuria (experiencing pain while urinating)[5]
Forms
Vaginal tablets, including Vagifem which contains
estradiol[6]
Vaginal creams, including
Premarin which is a compound cream[7] consisting primarily of conjugated
estrogens isolated from
mare'surine. Another vaginal cream is Ovesterin, which contains
estriol.
Vaginal rings (such as Oestring), which are polymeric
drug delivery devices designed to provide controlled release of drugs to the
vagina over extended periods of time. Although the
Femring might be able to ease hot flashes,[3] this does not appear to be the case for other vaginal estrogen rings or vaginal creams.[8]
Side effects
Most of the vaginally administered estrogens are synthetic and therefore cause the following side effects[9]
Serious side effects:
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
sudden numbness or weakness, especially on one side of the body;
sudden severe headache, confusion, problems with vision, speech, or balance;
pain, swelling, warmth, or redness in one or both legs;
changes in your menstrual periods, decreased sex drive; or
headache, nervousness, dizziness, tired feeling.
Contraindications
Estrogen administered vaginally should not be given to persons who are:
Pregnant women
Estrogen should not be used while pregnant as it could cause serious
birth defects.
Breastfeeding
Estrogen passes into the breast milk and will cause a decrease in the production and quality of
breast milk.
Alternatives
To effectively alleviate the symptoms of menopause, it is best to take oral estrogen instead of topical estrogen since the results are systemic and it will rejuvenate the entire reproductive system and not just the
perineal area.[11][additional citation(s) needed]
Phytoestrogens are plant derived compounds found in a wide variety of foods. Several health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms are frequently attributed to phytoestrogens but many are also considered to have the potential to cause adverse health effects.[12] Plants such as
Kacip Fatimah have been found to contain phytoestrogens that could alleviate some symptoms of menopause.[13]