Hormone Therapy and Vaginal Estrogen

“Vaginal oestrogen is a hormone replacement therapy (HRT)
medicine that contains the hormone oestrogen.
It’s used to treat the vaginal dryness and irritation…”.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 (NAMS) 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?

DotS the definition of vaginal oestrogen may vary. In Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen the NHS definition is:

“Vaginal oestrogen is a hormone replacement therapy (HRT) medicine that contains the hormone oestrogen. It’s used to treat the vaginal dryness and irritation that can happen during the menopause”.3

On page one in Deciding About Hormone Therapy 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)”.4

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy, published online 30 October 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.5

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”.6

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 online 10 June 2022, one of the recommendations is:

Hormone Therapy and Vaginal Estrogen

  • “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”.7

Compounded Vaginal Estrogen and Testosterone

Are compounded vaginal estrogen and testosterone recommended?

On page two in Vaginal Dryness, published November 2022, the NAMS include:

“Notes: Compounded vaginal estrogen and testosterone are not FDA regulated or recommended for treatment of GSM in most cases”.8

What is FDA?

FDA in this context, is an abbreviation for the (United States) Food and Drug Administration.

What is GSM?

GSM in this context, is an abbreviation for the Genitourinary Syndrome of Menopause.

Health Care Provider

What if my vaginal symptoms do not improve with treatment?

On page two in Vaginal Dryness, published November 2022, the NAMS explain:

“Notes: Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.9

Health Topics A-Z

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

In Health Topics A-you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  2. BMS TV: Bioidentical Hormones
  3. BMS TV: Hormone Replacement Therapy (HRT)
  4. BMS TV: Urogenital Atrophy
  5. BMS TV: Testosterone Explained
  6. Bioidentical Hormones: Are They Safer?
  7. Caredownthere
  8. Consumer Health: Treating Vaginal Dryness After Menopause
  9. Deciding About Hormone Therapy
  10. Deciding About Hormone Therapy Use
  11. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  12. Endometrial Safety of Low-Dose Vaginal Estrogens
  13. Endometrial Safety of Low-Dose Vaginal Estrogens [Video]
  14. Estradiol Vaginal Cream
  15. Estrogen (Vaginal Route): Before Using
  16. Estrogen (Vaginal Route): Description and Brand Names
  17. Estrogen (Vaginal Route): Precautions
  18. Estrogen (Vaginal Route): Proper Use
  19. Estrogen (Vaginal Route): Side Effects
  20. Estrogen Vaginal
  21. Experiencing Vaginal Dryness? Here’s What You Need To Know
  22. HRT
  23. HRT – Types, Doses and Regimens
  24. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT)
  25. Hormone Replacement Therapy (HRT): Vaginal Oestrogen
  26. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – About Vaginal Oestrogen
  27. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  28. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  29. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Side Effects of Vaginal Estrogen
  30. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Using Vaginal Oestrogen With Other Medicines and Herbal Supplements
  31. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Who Can and Cannot Use Vaginal Oestrogen
  32. Hormone Therapy: Is It Right for You?
  33. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  34. I Forgot To Ask the Doctor – E9: The Menopause: Can Every Woman That Wants It Have HRT?
  35. International Society for the Study of Women’s Sexual Health: Find A Provider
  36. 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
  37. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  38. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life]
  39. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Supporting Someone Through the Menopause [+ Video: Men Don’t Need To Know About Menopause]
  40. Let’s Talk About Perimenopause
  41. Looking After Yourself: Sex and Relationships
  42. Lubricant Alternatives: What To Use and What To Avoid
  43. Managing Your Symptoms: Managing Bladder, Vaginal and Vulval Problems
  44. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  45. Menopause
  46. Menopause
  47. Menopause Map: Downloadable Resources – My Personal Path Print Tools – Questions for Your Health Care Provider
    Hormone Therapy and Vaginal Estrogen
  48. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  49. Menopause Patient Information [Videos] 4. The Different Types of HRT
  50. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  51. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  52. Menopause Ruining Your Sex Life?
  53. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  54. Menopause Treatments: What Works, What Doesn’t – Treatments for Vaginal Dryness
  55. Menopause and HRT
  56. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  57. Menopause: Menopause – Hormone Treatments
  58. Menopause: Things You Can Do
  59. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  60. Mymenoplan.org [My Menoplan, United States]
  61. Natural Remedies To Help Manage Perimenopause Symptoms
  62. Navigating Menopause Together: How Partners Can Help
  63. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  64. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  65. Perimenopause and Menopause Symptom Checklist
    Hormone Therapy and Vaginal Estrogen
  66. Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)
  67. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
  68. Risks and Benefits of MHT
  69. Supporting A Loved One Through Menopause
  70. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  71. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  72. Therapy for the Effects of Menopause
  73. Tips To Help Manage Menopause Symptoms
  74. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  75. Urogenital Problems
  76. Urologic View In the Management of Genitourinary Syndrome of Menopause
  77. Using Natural Therapies In the Menopause Transition – Webinar
  78. Vaginal Atrophy
  79. Vaginal Dryness
  80. Vaginal Dryness
  81. Vaginal Dryness
  82. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?
  83. Vaginal Dryness Alternative Treatments
  84. Vaginal Dryness: Treatment Options
  85. Vaginal Dryness: What To Do About It
  86. Vaginal Estrogen
  87. Vaginal Laser Therapy for GSM/VVA: Where We Stand Now – A Review By the EUGA Working Group on Laser
  88. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  89. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  90. Video Series-2023: NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  91. Video Series-2024: Preparing for Your Menopause Health Care Visit
  92. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  93. Videos and Podcasts: Videos – Interviews: Vulvovaginal Atrophy
  94. Vulva and Vaginal Health: Getting the Right Advice
  95. Vulvovaginal Atrophy
  96. Vulvovaginal Health
  97. Webinars: Previous – Genitourinary Syndrome of Menopause
  98. Webinars: Previous – Pay Attention on Your Way In! The Vulva Is An Important Organ Too
  99. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit
  100. Wild Yam

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen. Page Last Reviewed: 27 January 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/ Accessed: 11 April 2024
  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: 11 April 2024
  3. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen. Page Last Reviewed: 27 January 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/ Accessed: 11 April 2024
  4. 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: 11 April 2024
  5. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy. First Published Online 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 11 April 2024
  6. Vulvovaginal Atrophy: Topical Vaginal Estrogens. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 11 April 2024
  7. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 11 April 2024
  8. Vaginal Dryness. 2022:2. https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 11 April 2024
  9. Vaginal Dryness. 2022:2. https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 11 April 2024
Topic Last Updated: 11 April 2024 – Topic Last Reviewed: 11 April 2024

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