Topical oestrogen (creams and pessaries) are commonly used in
postmenopausal women to improve the quality of the vaginal epithelium in
atrophic vaginitis.
Fifteen percent of premenopausal women, 10-40% of
postmenopausal women, and 10-25% of women receiving
systemic hormone therapy experience urogenital atrophy.
The most common symptoms are dryness, burning, pruritus,
irritation, and dyspareunia (painful sexual intercourse).
Topical Estrogen or hormone
replacement therapy (ERT-HRT) is the treatment of choice
in postmenopausal women.0101
If genital symptoms, such as vaginal dryness,
pain during lovemaking or perhaps bladder symptoms are troubling you, these could be due to reduced oestrogen levels in the tissues around the genital area. These symptoms usually respond to HRT or to topical preparations (oestrogen creams or pessaries).
On occasion, local symptoms may fail to respond to HRT anyway and additional topical oestrogen may be required.
To begin with, the creams or pessaries are introduced each night for ten days to two weeks and then reduced to a maintenance regime varying from twice weekly to perhaps no more than once each month depending on symptoms, age and response. There are a variety of topical oestrogen preparations (Table 28.1).
Estring (Pharmacia and Upjohn), a synthetic soft rubber ring which slowly releases oestradiol can be introduced into the vagina and replaced at three monthly intervals. If the uterus is still present intermittent courses of progestogen should be considered to encourage endometrial shedding (HRT and progestogen). The ring is as effective as oestrogen creams and some women find the ring more acceptable.
Table 28.1 Topical creams and pessaries that
are commonly used in menopause treatment.
|
Preparation |
Oestrogen |
Company |
| Ortho-Gynest Pessaries |
Oestriol 500 g |
Janssen-Cilag |
| Ortho-Gynest Cream |
Oestriol 0.01% |
Janssen-Cilag |
| Ovestin Cream |
Oestriol 0.1% |
Organon |
| Ovestin Pessaries |
Oestradiol 1mg |
Organon |
| Premarin Cream |
Conjugated oestrogens 625 mg |
Wyeth |
| Vagifem Pessaries |
Oestradiol 25 microg |
Novo Nordisk |
| Estring Ring |
Oestradiol (7.5 microg release/day) |
Pharmacia and Upjohn |
