Hormone Therapy and Vaginal Estrogen

“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 online 10 June 2022, one of the recommendations is:

  • “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:

Health Topics A-Z

Links

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

Your Country may have Links similar to:

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.

New or Updated

  1. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  2. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  3. Bioidentical Hormones Explained – A British Menopause Society Video
  4. Bioidentical Hormones: Are They Safer?
  5. Caredownthere
  6. Complementary Medicine Options for Menopausal Symptoms
  7. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  8. Consumer Health: Treating Vaginal Dryness After Menopause
  9. Deciding About Hormone Therapy
  10. Deciding About Hormone Therapy Use
  11. Dr Gail Busby – I Forgot To Ask the Doctor – Episode 9 The Menopause
  12. EMAS Menopause Essentials
  13. EMAS Replay [Webinars]
  14. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  15. Early Treatment of Vulvovaginal Atrophy May Prevent Distressing Symptoms
  16. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  17. Easier Access To Locally-Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [Medicines & Healthcare Products Regulatory Agency, GOV.UK]
  18. Estradiol Vaginal Cream
  19. Estrogen (Vaginal Route): Before Using
  20. Estrogen (Vaginal Route): Description and Brand Names
  21. Estrogen (Vaginal Route): Precautions
  22. Estrogen (Vaginal Route): Proper Use
  23. Estrogen (Vaginal Route): Side Effects
  24. Estrogen Vaginal
  25. Experiencing Vaginal Dryness? Here’s What You Need To Know
  26. HRT
  27. HRT: Benefits and Risks
  28. HRT: Types, Doses and Regimens
  29. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  30. Hormone Replacement Therapy (HRT): Alternatives
  31. Hormone Therapy: Is It Right for You?
  32. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  33. International Society for the Study of Women’s Sexual Health: Find A Provider
  34. 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
  35. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing and Intimacy During and After Menopause [+ Video: Menopause Is the End of Your Sex Life]
  36. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  37. 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]
  38. Looking After Yourself: Sex and Relationships
  39. Managing Your Symptoms: Managing Bladder, Vaginal and Vulval Problems
  40. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  41. Menopause
  42. Menopause
  43. Menopause
  44. Menopause
  45. Menopause
  46. Menopause
  47. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  48. Menopause FAQs: Menopause Symptoms – Q. How Can I Counteract Vaginal Dryness During Menopause?
  49. Menopause Map: Downloadable Resources – My Personal Path Print Tools – Questions for Your Health Care Provider
  50. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  51. Menopause Patient Information [Videos] 4. The Different Types of HRT
  52. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  53. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  54. Menopause Ruining Your Sex Life?
  55. Menopause Treatments: What Works, What Doesn’t – Treatments for Vaginal Dryness
  56. Menopause and Sex – Fact Sheet
  57. Menopause: Diagnosis & Treatment
  58. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  59. Menopause: Menopause – Hormone Treatments
  60. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  61. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  62. Natural Remedies To Help Manage Perimenopause Symptoms
  63. Navigating Menopause Together: How Partners Can Help
  64. NonHormonal Treatments for Menopausal Symptoms
  65. Oestrogen Only Menopausal Hormone Therapy
  66. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  67. Public Assessment Report – Prescription Only Medicine To Pharmacy Reclassification – Gina 10 Microgram Vaginal Tablets
  68. Recent Review Confirms Safety of Low Dose Vaginal Estrogen: July 2019
  69. Risks and Benefits of MHT
  70. Safety of Vaginal Estrogens: A Recap of A Systematic Review [Video]
  71. Supporting A Loved One Through Menopause
  72. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  73. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  74. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  75. Urogenital Atrophy Explained – A British Menopause Society Video
  76. Urogenital Problems
  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 Estrogen
  86. Video Series-2021: Common Issues Surrounding Sexuality and Menopause
  87. Video Series-2021: How Menopause Symptoms Can Affect Your Quality of Life
  88. Video Series-2021: Treatment Options for Vaginal Dryness and Urinary Issues
  89. Video Series-2021: What Women Need To Know About Hormone Therapies
  90. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  91. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  92. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  93. Videos and Podcasts: Interviews and Podcasts – Interviews: Vulvovaginal Atrophy
  94. Vulva and Vaginal Health: Getting the Right Advice
  95. Vulvovaginal Atrophy
  96. Vulvovaginal Health
  97. Vulvovaginal Symptoms After Menopause
  98. Webinars: Previous – VVA – The Silent Epidemic
  99. Wild Yam
  100. Women’s Wellness: Vaginal Atrophy After Breast Cancer

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: 12 January 2023
  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: 12 January 2023
  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: 12 January 2023
  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: 12 January 2023
  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. First Published Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 12 January 2023
  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: 12 January 2023
  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: 12 January 2023
Topic Last Updated: 12 January 2023 – Topic Last Reviewed: 12 January 2023

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