Oestrogen vaginal cream and pessaries

Applying oestrogen directly to the vagina has several advantages.

• By using the cream or pessaries, the levels of oestrogen in your vaginal area increase which helps relieve symptoms.
• The oestrogen levels in your blood aren't raised significantly, which minimises the effect of oestrogen in other areas such as the breast or uterus.
• Vaginal oestrogen is safe to use long-term, as long as you haven’t had breast cancer.
• If you have had breast cancer, talk to your doctor about whether vaginal oestrogen is an option for you.

Read more about menopausal hormone therapy (MHT).

• Symptoms of menopause: use once every evening until there is an improvement, and then 2 times a week for as long as is needed. It may take several days or even weeks before you notice an improvement. This treatment usually works well but the symptoms may come back after stopping the treatment.
• Vaginal surgery: use every evening for 2 weeks before surgery, then twice a week for 2 weeks after surgery.

Ask your healthcare provider or pharmacist to explain how to use vaginal cream or pessaries. The following is a guide.

Vaginal cream

• Vaginal cream comes in a tube with special applicators that you need to fill with the cream. The applicator is used to measure the right dose of cream and to insert the cream inside your vagina. 
• Fill the applicator with cream to the ring mark – do not completely fill the whole applicator. 
• Vaginal cream is best applied at night, before going to sleep.
• To clean the applicator, pull the plunger and wash these in warm (not boiling), soapy water. Do not use detergents. Rinse well and dry afterwards. 
• If you forget a dose, use it as soon as you remember. But if it's the next day, just use the next dose at the right time. Don't use double the dose in one day.

Vaginal pessaries

• Vaginal pessaries are a moulded tablet that is inserted into your vagina.
• The pessary is best inserted at night, before going to sleep.
• To make it easier to insert, you may need to moisten the pessaries with water first.
• Remove one pessary from its wrapper. Either using a squatting position or lying on your back or side, insert the pessary deeply into the vagina with your finger.
• If you forget a dose, use it as soon as you remember. But if it's the next day, just use the next dose at the right time. Don't use double the dose in one day.

Like all medicines, vaginal oestrogen can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.