Estriol cream

Estriol cream is a type of hormone replacement therapy that is applied directly inside the vagina using an applicator. It contains the active ingredient estriol, a type of oestrogen, which is a natural female hormone.

Estriol cream contains 0.01% estriol, which means you’re getting 1mg of estriol for every 1g you apply. The estriol in the cream is manufactured in a laboratory, but has the same structure as the natural hormone.

Estriol cream can be used by people going through menopause who are experiencing vaginal symptoms such as irritation and dryness. As it’s applied directly into the vagina and only works in this area, it causes fewer side effects than types of HRT which affect the whole body (systemic HRT), such as tablets and patches.

Estriol cream works to relieve symptoms in the vagina caused by menopause because it replaces your naturally declining oestrogen levels. With age and time, your ovaries start to produce less oestrogen. Oestrogen production can also stop in women who have had their ovaries removed.

When oestrogen levels are low, the vaginal wall can become thinner and dry, which can make sex painful and may also lead to vaginal infections. It can also cause vaginal symptoms like:

• itching
• burning
• pain after sex
• dryness
• urinary symptoms (needing to pee more often or urgently, and pain when peeing)

These symptoms can be relieved by replacing the body’s own oestrogen with an artificial kind, such as estriol. Estriol vaginal cream is a topical treatment. This means that it should be applied directly to the area where symptoms occur, which can reduce side effects that affect other areas of the body.

How long does estriol cream take to work?

The cream starts working right away, but takes around 1 to 2 hours for the strongest effect as it reaches its highest concentration in your body. Although it starts working quickly, it may take a few weeks of daily use to notice a big difference, and up to 3 months to work fully for improving your symptoms.

How effective is estriol cream?

In clinical trials, estriol cream was effective at relieving vaginal menopause symptoms from week 1 onwards.

Apply estriol 0.01% cream once a day for up to 4 weeks. Once symptoms start improving, you should reduce how often you use the cream to 1 application twice a week unless otherwise instructed by a healthcare professional.

If you’re switching over from another type of HRT, you will need to wait a week (7 days) after finishing your previous HRT to safely start using estriol cream.

How to use Estriol cream

We recommend using estriol cream right before bed and using the toilet before application so the cream can stay inside the vagina for a long time and take effect. Follow these steps or the instructions that come with your medication:

1. Remove the cap from the tube and turn it upside down. Then use the sharp point to open the tube.

2. Screw the end of the applicator onto the tube.

3. Squeeze the tube to fill the applicator with the cream up to the red ring mark (the plunger will stop at the ring mark). When filled to the ring, the dose is 0.5mg of estriol.

4. Unscrew the applicator from the tube and put the cap back on the tube.

5. To apply the cream, lie down, put the end of the applicator deep into the vagina and slowly push the plunger all the way in.

After use, pull the plunger out of the barrel and wash both of them in hot soapy water (not boiling water). Do not use detergents. Rinse well with clean water afterwards.

What if I miss a dose of estriol cream?

If you forgot to take your estriol cream and it:

• has been 12 hours or less since you were meant to take it – take it as soon as you remember
• has been more than 12 hours since you were meant to take it – skip the missed dose and take the next one as normal

2 doses should never be applied in 1 day, or you’re more likely to get side effects. If you’ve used more estriol cream than you should, speak to a pharmacist or a doctor.

How long do you need to take estriol cream for?

Most often, HRT is used for around 2 to 5 years. You should take estriol cream for as long as it is safe for you to take it and so long as your healthcare provider has prescribed it to you.

To start with, you’ll get the best effects from applying estriol cream daily, but once your symptoms improve, you can reduce this down to a few times a week.

Most people take estriol cream without any problems, but it is possible to experience side effects.

When using estriol, you may get side effects like:

• nausea (feeling sick) and vomiting (being sick)
• breast tenderness or pain
• vaginal bleeding or spotting
• increased production of cervical mucus
• headaches
• vaginal irritation and itching
• flu-like illness

These side effects usually improve with time, but they may be a sign that you’re taking too much of the cream. Speak to a healthcare professional if you’re concerned or if these symptoms do not go away and begin to disrupt your day-to-day life.

Stop using the cream immediately if you get any of the following serious side effects and speak to a doctor straight away or call 999 in an emergency:

• jaundice – yellowing of your skin or the whites of your eyes
• severe allergic reaction, a medical emergency – swollen face, tongue, and throat, difficulty swallowing or hives, and difficulty breathing
• a large rise in your blood pressure – headache, tiredness, and dizziness
• migraine-like headaches, which happen for the first time
• signs of a blood clot – painful swelling and redness of the legs, sudden chest pain, or difficulty in breathing

You must stop using estriol cream straight away if you find out you’re pregnant.

Taking HRT tablets can increase the risk of thickening and cancer of the womb lining. It’s unclear whether using estriol cream may also increase the risk if used long-term, but it’s unlikely, as the cream is applied to the vagina and only a small amount of estriol enters the bloodstream.

HRT tablets can also increase the risk of breast cancer and ovarian cancer, and it’s also possible that estriol cream could increase this risk, although only in women who have had breast cancer in the past. The risk for women who have not had breast cancer and are prescribed estriol cream is unknown. Similarly, HRT tablets can increase the risk of blood clots and cardiovascular disease (like heart attacks and strokes), but because estriol is a topical treatment, this risk is much lower.

Estriol cream may not be right for everyone. Certain conditions or certain medications can interact with estriol cream and make it less effective, or potentially unsafe.

You should not use estriol cream if you are pregnant, might become pregnant, or if you are breastfeeding.

Estriol cream is not a contraceptive, and you may still be able to get pregnant if you’re under 50 or it’s been fewer than 12 months since your last period. Make sure to use a form of contraception when having sex if this is the case. Estriol cream can damage latex condoms, so you should use an alternative method of contraception.

Do not use this medication if you:

• are allergic to estriol or any of the other ingredients
• have or have ever had breast cancer, or if you are suspected of having it
• have cancer which is sensitive to oestrogens, such as cancer of the womb lining, or if you are suspected of having it
• have any unexplained vaginal bleeding
• have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated
• have or have ever had a blood clot in a vein
• have a blood-clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke, or angina
• have or ever have had a liver disease, and your liver function tests have not returned to normal
• have a rare blood problem called porphyria, which is passed down in families (inherited)

Tell your doctor if you have ever had any of the following problems, before you start the treatment, as you may need to see your doctor more often for check-ups:

• fibroids inside your womb
• growth of the womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
• increased risk of developing blood clots
• increased risk of getting an oestrogen-sensitive cancer, such as having a mother, sister, or grandmother who has had breast cancer
• high blood pressure
• a liver disorder, such as a benign liver tumour
• diabetes
• gallstones
• migraine or severe headaches
• a disease of the immune system that affects many organs of the body (systemic lupus erythematosus)
• epilepsy
• asthma
• a disease affecting the eardrum and hearing (otosclerosis)
• fluid retention caused by cardiac or kidney problems
• hereditary and acquired angioedema

Some medications can interact with estriol cream, which can make one medication work less effectively or cause a reaction. Speak to a healthcare professional if you are taking any of the following:

• medicines for epilepsy, such as barbiturates, hydantoins and carbamazepine
• medicines for infections, such as griseofulvin and rifamycins
• medicines for viral infections, such as nevirapine, efavirenz, ritonavir, or nelfinavir
• herbal preparations containing St John’s wort
• corticosteroids
• succinylcholine
• theophyllines
• troleandomycin
• ombitasvir/paritaprevir/ritonavir, with or without dasabuvir for hepatitis C

Estriol cream can:

✓ provide effective relief from vaginal dryness, discomfort, and itching

✓ make sex less uncomfortable

✓ improve urinary symptoms, such as recurrent infections, having to pee more often, and a sudden urge to pee

✓ cause fewer side effects than HRT tablets

HRT tablets release hormones into the bloodstream and act on the whole body, while estriol vaginal cream acts mostly on the vagina, with only a small amount of estriol released into the blood. That’s why there are usually fewer side effects.

You can buy estriol cream from an online pharmacy or doctor service that can prescribe HRT, or you can get it on the NHS. It’s not available over the counter.

Can I buy estriol vaginal cream online?

Yes, you can buy estriol cream online from a reputable online prescribing service like Asda Online Doctor. Simply complete a quick consultation about your treatment. A doctor will then check whether estriol cream is the right treatment for you. If approved, your medication will be sent directly to your address or chosen Asda pharmacy.

We also have plenty of other HRT options if you have menopause symptoms affecting the whole body, such as hot flushes. In this case, HRT tablets or patches may be more beneficial. If you’re not sure, complete our consultation and one of our doctors can recommend a treatment for you.

Can I buy estriol cream over the counter?

No, estriol cream is a prescription-only medication, so you cannot buy it over the counter from a pharmacy.

Can I get estriol cream on the NHS?

Yes, you can get estriol cream on the NHS after a consultation with your GP if they think it is suitable for you.

Estriol cream comes as an unbranded variety or under the brand name Ovestin. Ovestin contains the same active ingredient at the same concentration and is also available from Asda Online Doctor. If you’d prefer, you can use vaginal tablets such as Vagirux instead, which treat the same symptoms but come in the form of a tablet that dissolves inside the vagina.

Vaginal rings can also help with vaginal menopause symptoms. They’re inserted into the vagina and also release oestrogen locally. We do not currently stock these.

If you have other menopause symptoms, as well as vaginal ones, other types of HRT medications can be used, including:

• tablets that contain oestrogen, progesterone, or both, like Elleste Duet Conti tablets
• patches, such as Estradot 50

You may prefer to use patches or a cream for HRT if you find it difficult to remember when to take tablets. Topical treatments such as gels and creams are great alternatives if you get side effects on HRT tablets but are still having symptoms of the menopause.