Estriol Cream

Estriol cream treats the vaginal symptoms of menopause – it is a common choice of topical treatment used to treat symptoms such as vaginal inflammation, dryness and painful sex. Menopause causes your sex hormones to decline gradually. Symptoms occur due to the decline in the main female sex hormone, oestrogen. Estriol is a type of hormone replacement therapy (HRT) which helps women to manage their symptoms better by replacing the declining hormones.

How does it work? – topical HRT like Estriol improves symptoms affecting the vagina, which are caused by a lack of oestrogen. The active ingredient in the cream is estriol, which is a type of oestrogen. It is one of three main oestrogens produced by your body. This adds extra oestrogen to your vagina, which helps to relieve symptoms.

How do you use it? – the cream comes in a pack with a clear plastic applicator, which is used to apply the cream into your vagina. The applicator has a ring marked on the body which indicates where you need to fill the cream up to for the correct dose. See the section of this page called 'how to use estriol for more information.

You can order your estriol cream from us online – our quick and easy service provides a convenient way of getting your medicine without having to order a repeat prescription from your GP or collecting your medicine from a local pharmacy. At ZAVA, we provide a service for ordering your HRT easily online. Fill out a short online assessment and your ZAVA Doctor will check if your treatment is still right for you. If it is, your order will be sent to your preferred address.

The advantages of using our service are that it:

• is easy to use
• is fast and discreet delivery
• avoids the need for a face to face consultation with a doctor
• is quick – you do not need to make appointments or go to the pharmacy to get your medication dispensed

How else can I buy estriol cream? – It is only available on a prescription. You would need to get an assessment and a prescription from a doctor and then get your prescription filled in pharmacy.

It’s right for people with vaginal menopause symptoms – estriol cream is used to treat vaginal symptoms caused during menopause as a result of too little oestrogen. It is also used before operations on the vagina. It could be right for you if you have any of the following symptoms that are troublesome during your menopause:

• Vaginal dryness
• Itchiness
• Vaginal burning (inflammation)
• Vaginal tightness
• Discomfort or pain during sex
• More frequent urinary tract infections
• Painful peeing (urination)

When shouldn’t I use estriol cream? – estriol cream is not right for everyone. Some people shouldn't use it because of pre-existing health conditions. See the 'contraindications of estriol cream' section on the right for more information.

Does estriol cream interact with any medicines? – estriol cream doesn’t usually interact with other medicines as it is a topical treatment, but the following medicines could potentially cause an interaction:

• Anti-epileptic medicines such as carbamazepine or lamotrigine
• Anti-infectives such as griseofulvin, ritonavir or nelfinavir
• St John’s Wort (Hypericum Perforatum)

If you’re using these medications it doesn’t mean that you cannot use estriol cream, as the effects are likely to be quite small. But your treatment might have to be monitored more closely.

This depends on your symptoms – if you have vaginal symptoms as it is a topical treatment. Your doctor will decide if this is the best treatment for you depending on your medical history and how troublesome your symptoms are.

Advantages of estriol cream treatment:

• Less risk of side effects in comparison to tablets or patches
• Less risk of interactions
• Less risk of overdose
• The maintenance dose is twice a week making it easier to use
• Can be only a short term treatment or periodic depending on how you respond

Disadvantages:

• May be difficult to use initially
• The applicator needs to be washed after each use
• Not helpful for menopause symptoms affecting other parts of your body such as hot flushes. It also doesn’t protect you against the longer term effects of the menopause such as osteoporosis

Alternatives HRT treatments are available:

• Tablets – one of the most common ways of taking HRT. These are usually once a day. Both oestrogen-only and combined HRT tablets are available
• Skin patches – skin patches are also another common way of using HRT patches. They are also available as oestrogen-only or combined HRT patches. You stick them onto your skin and replace them every few days
• Vaginal ring – this is a ring that sits inside the vagina and releases oestrogen. It’s similar to using vaginal oestrogen creams like estriol, as it helps with menopause symptoms affecting the vagina
• Hormonal coil – hormonal coils like the Mirena can be used on their own or in combination with oestrogen-only HRT
• Implants – HRT implants are pellet like devices inserted under your skin (usually in your stomach area) by using a local anaesthetic to numb your skin. The implants gradually release oestrogen over several months and can be replaced when needed
• Oestrogen gel – like skin patches, oestrogen gel is another way of using HRT. The gel is applied once a day to your skin and is easily absorbed

HRT tablets or patches are a more suitable choice if you have menopause symptoms that affect other parts of your body such as hot flushes. Using patches can also help avoid some of the side effects of HRT tablets such as indigestion and unlike tablets they don’t increase the risk of blood clots. There is a slightly higher risk of blood clots with taking HRT tablets although the overall risk is small.

Estriol cream can cause side effects – but not everybody gets them. There is a very low risk of overdose as you apply the cream with a plunger. If you are concerned about an overdose, then speak to your doctor. Do not double up on a missed dose.

What to do about side effects – most side effects if they do occur, disappear after a few weeks of treatment. If they become troublesome, then speak to your doctor. Always report any unusual vaginal bleeding or spotting to your doctor. When to stop treatment – you should immediately discontinue treatment if any of the following develop:

• New onset of a migraine type headache
• Pregnancy
• Jaundice or worsening of liver function
• Significant increase in blood pressure
• A severe allergic reaction – symptoms include swelling of the face, tongue or neck, difficulty breathing and a rash

Other risks – HRT is associated with a small increased risk of breast cancer. The risk reduces once you stop HRT. Estriol cream and other topical vaginal oestrogen HRT isn’t associated with this increased risk. It’s always important to attend your breast screening appointments and to see your doctor if you notice any changes like:

• dimpling of the skin
• changes to the nipple
• any lumps that you can see or feel

Oestrogen-only HRT can increase the risk of womb cancer. Studies on ovarian cancer have shown conflicting results. It is still important to report any symptoms to your doctor. These can include:

• swollen stomach
• constant bloating
• loss of appetite
• vaginal bleeding – particularly after the menopause, or between normal periods
• pain during sex
• pelvic pain

When to get emergency help – seek immediate medical attention or visit your nearest A&E if you experience any of these rare but serious effects:

• Blood clots (including sharp chest pain, sudden breathlessness, pain and swelling in the legs)
• Heart attack (including chest pain radiating to the arms, face or jaw, fainting, shortness of breath)
• Stroke (sudden numbness of one side of the body, sudden trouble seeing, speaking or walking)
• Unexplained migraine-type headache with or without disturbed vision may be an early warning sign of a stroke
• Allergic reaction (face, mouth or throat swelling or difficulty breathing)
• Severe liver problems (including yellow eyes or skin)

The patient information leaflet with your estriol cream will provide more specific information about how to take your HRT, associated risks, interactions, side effects and any contraindications.