Oestrogen for HRT (Topical)

About Oestrogen for HRT (Topical)

This belongs to the group of medicines known as Oestrogens.

Oestrogen is a female hormone. Topical oestrogen can be used to treat dryness of the vagina that occurs as a result of the menopause.

During the menopause or change, your female hormone levels begin to fall. The menopause normally happens between the ages of 45 and 55, although it can occur earlier or later. This fall in hormones can cause the lining of the vagina to become drier and thinner and you may feel uncomfortable, especially when having sex. Applying oestrogen to the area helps to relieve these symptoms.

Oestrogen is sometimes spelt as estrogen.

Topical oestrogen is available in vaginal cream, pessary and vaginal ring form.

Different types of oestrogen may be used in these products. These include estriol, conjugated oestrogens and estradiol.

Brands available are: Ortho-Gynest; Ovestin; Premarin; Vagifem; Estring. You may notice the use of any of these names on the packaging of your medicine.

Before Using Oestrogen for HRT (Topical)

Before using topical Oestrogen make sure your doctor or pharmacist knows:

• if you are pregnant, trying for a baby or breast-feeding
• if you have ever had an allergic reaction to this or any other medicine
• if you have any vaginal bleeding for which the cause has not been found
• if you suffer from thrombosis (blood clots), kidney, liver or gall-bladder problems
• if you have prolonged periods of immobilisation (use a wheelchair or confined to bed for example)
• if you suffer from otosclerosis (a disease of the bones of the inner ear causing hearing impairment)
• if you suffer from migraine, epilepsy, diabetes, high blood pressure or porphyria (blood disorder)
• if you have multiple sclerosis (MS), tetany (numbness and tingling in hands, feet and around the mouth)
• if you have cancer of the breast or uterus, or have had it in the past, or have a family history of this condition
• if you are allergic to peanuts; some preparations contain peanut (arachis) oil
• if you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines

How to Use Oestrogen for HRT (Topical)

• Always read the manufacturer's information leaflet, if possible, before beginning treatment.
• Vaginal Cream - Use the applicator to insert the prescribed amount into the vagina.
• Pessary - Use the applicator provided to insert the pessary into the vagina
• Vaginal ring - This is inserted by a doctor. It will need to be replaced after 3 months.
• Your doctor may stop your treatment after 3 to 6 months to see if you still need to continue with it. If your symptoms return go back to your doctor.
• Never use more than the prescribed dose. If you suspect that you or someone else has taken or used an overdose of Oestrogen contact your doctor or go to the accident and emergency department of your local hospital at once. Always take the container with you, if possible, even if empty.
• This medicine is for you. Never give it to others even if their condition appears to be the same as yours.

Getting the most from your treatment

• Before taking any 'over-the-counter' medicines, check with your pharmacist which medicines are safe for you to take alongside topical Oestrogen.
• You must keep your regular appointment with your doctor. This treatment should be reviewed at least once a year.
• If you experience other menopausal symptoms such as hot flushes speak to your doctor as you may need to change your medicine to another form of HRT.
• If you wear contact lenses they may become irritating, if this becomes a problem speak to your optician.
• Before having any kind of medical treatment including dental treatment or any medical tests you must tell them you are using topical oestrogens.

For patients who have not had a hysterectomy (removal of the womb)

HRT does not provide contraception. If you are still having menstrual periods you can still become pregnant. If you are under 50 years old you can remain fertile for one year after menstrual periods have stopped. You should not take the contraceptive pill while you are on HRT, you are advised to use other methods such as condoms or a cap. However some forms of topical oestrogen may damage latex condoms and diaphragms. Ask you pharmacist or doctor for suitable methods of contraception. If you suspect you might be pregnant, stop using this medicine at once and consult you doctor as soon as possible.

If you need to use contraception DO NOT use the rhythm method. Your usual menstrual cycle will become less regular during menopause; therefore this method would be unreliable.

Topical oestrogens are less likely to have the risks of other forms of HRT. For more information about the risks and benefits of HRT see the DIL - Oestrogen for HRT.

Can Oestrogen cause problems?

Along with their needed effects, all medicines can cause unwanted side effects, which usually improve as your body adjusts to the new medicine.

Topical oestrogens tend to have fewer side effects than other forms of HRT. You may experience itching or soreness after applying the product, however speak with your doctor if any of the following side effects continue or become troublesome.

Feeling or being sick, stomach cramps, bloating, weight change, breast enlargement and tenderness, pre-menstrual-like syndrome, swollen ankles, rash, brown blotchy marks on the skin, nose bleeds, change in sex drive, depression, headaches, migraine, dizziness, leg cramps, contact lens irritation.

Important:If you experience any of the following contact your doctor or go to the accident and emergency department of your local hospital IMMEDIATELY: sudden severe chest pains, sudden breathlessness, cough with blood-stained mucus, severe pain in calf of one leg, severe stomach pain, unusual severe prolonged headache, sudden partial or complete loss of vision, sudden disturbance of hearing or other perceptual disorders, severe indigestion, bad fainting or collapsing attacks, first unexpected epileptic attack, weakness, problem with movement, sudden numbness affecting one part or half of the body, severe jaundice (yellowing of the skin and whites of the eyes).

If you experience any other worrying side effects, which you think may be due to this medicine, discuss them with your pharmacist or doctor.

How to store Oestrogen for HRT (Topical)

• Keep all medicines out of the reach of children.
• Store in a cool, dry place, away from direct heat and light.
• Never keep out of date or unwanted medicines. Discard them safely out of the reach of children or take them to your local pharmacist who will dispose of them for you.

© EMIS 2005   Updated: 25/01/2005