“If you are bothered only by vaginal dryness,
you can use very low doses of estrogen
placed directly into the vagina”.1

Umbrella
What may the Hormone Therapy and Vaginal Estrogen Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Local Low-Dose Estrogen Therapy
  • Menopausal Hormone Therapy (MHT)
  • Topical Vaginal Estrogens
  • Vaginal Estrogen/Oestrogen

Position Statement

When may vaginal estrogen be recommended?

On page one in The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract, published July 2022, the North American Menopause Society note:

“For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended”.2

Vaginal Estrogen

What is vaginal estrogen?

On page one in Deciding About Hormone Therapy, published July 2022, the NAMS explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.3

Cream, Tablet, Pessary or Ring

How can estrogen be applied directly to the vagina?

In Vulvovaginal Atrophy: Topical Vaginal Estrogens the European Menopause and Andropause Society explain:

Hormone Therapy and Vaginal Estrogen

  • “These may contain estradiol, estriol, promestriene and conjugated estrogens
  • Preparations include tablets, rings, capsules, creams, gels and ovules
  • Most are low-dose and do not change systemic estrogen levels
  • There is no need to add progestogen (for endometrial protection) when low-dose topical estrogens are used
  • They can be used alone or with systemic menopausal hormone therapy
  • They may also improve urinary incontinence and prevent recurrent urinary tract infections
  • They do not increase the risk of endometrial cancer, breast cancer, venous thromboembolism or cardiovascular disease”.4

Duration

How long can vaginal estrogen be used for?

On page three and four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published 10 June 2022, Hamoda et al. note:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.5

United Kingdom

From September 2022, will postmenopausal women “be able to access Gina 10 microgram vaginal tablets without requiring a prescription”?

In Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification, dated 20 July 2022, the British Menopause Society explain:

“From September women in the UK will be able to access Gina 10 microgram vaginal tablets without requiring a prescription.

For the first time ever in the UK, postmenopausal women will be able to access a low dose Hormone Replacement Therapy (HRT) product from their local pharmacies without prescription, the Medicines and Healthcare products Regulatory Agency (MHRA) announced today.

Gina 10 microgram vaginal tablets (containing estradiol) are used for the treatment of vaginal symptoms such as dryness, soreness, itching, burning and uncomfortable sex caused by oestrogen deficiency in postmenopausal women aged 50 years and above who have not had a period for at least 1 year. This product is locally applied, meaning it is inserted into the vagina and not taken orally”.6

Where may find more information about this landmark reclassification?

You may find more information about this landmark reclassification in:

Health Care Provider

What if I would like to use vaginal estrogen?

If you would like to use vaginal estrogen, it may be in your best interest to choose to talk to your health care provider about this.

In Menopause FAQs: Hormone Therapy – Q. What Is Hormone Therapy? the NAMS also note:

“You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you”.7

What is FDA?

FDA can be an abbreviation for the (United States) Food and Drug Administration.

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy and Vaginal Estrogen?

In Health Topics A-you may find:

Links

Where may I find Links related to Hormone Therapy and Vaginal Estrogen?

Your Country may have Links similar to:

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 03 November 2022
  2. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. 2022:1 North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 03 November 2022
  3. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 03 November 2022
  4. Vulvovaginal Atrophy: Topical Vaginal Estrogens. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 03 November 2022
  5. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. Fist published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 03 November 2022
  6. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification. 20 July 2022. British Menopause Society https://thebms.org.uk/2022/07/easier-access-to-locally-applied-hrt-to-treat-postmenopausal-vaginal-symptoms-in-landmark-mhra-reclassification/ Accessed: 03 November 2022
  7. Menopause FAQs: Hormone Therapy – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 03 November 2022
Topic Last Updated: 03 November 2022 – Topic Last Reviewed: 03 November 2022

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