Oestrogen vaginal cream and pessaries

Since vaginal oestrogen is applied directly into the vagina, hardly any is absorbed into the body, reducing the chance of side effects.

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. It's designed to work mainly in your vagina, bladder and pelvic floor.
• The oestrogen levels in your blood aren't raised, 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.
• It is safe for women who have a past diagnosis of endometrial, cervical or ovarian cancer.
• If you have had breast cancer, vaginal oestrogen is generally considered safe, so talk to your doctor about whether its an option for you.

Read more about menopausal hormone therapy (MHT).

• Vulval symptoms of menopause: Use once every night at bedtime for 2 to 3 weeks, 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. There is usually no need to stop treatment.
• Vaginal surgery: use every evening for 2 weeks before surgery, then twice a week for 2 weeks after surgery.

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

Vaginal cream

• The vaginal cream is best applied at night, before going to sleep.
• The 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.
• Get into a comfortable position, either standing up or lying down. Gently insert the applicator into your vagina and push the plunger as far as it will go.
• Alternatively, if you prefer not to insert the applicator, you can apply the vaginal cream using your finger. Empty the applicator onto the end of a clean finger and insert finger into your vagina.
• 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 inserted into your vagina. They are shaped like an oval and are made with coconut oil, so they melt easily once inserted.
• The pessary is best inserted at night, before going to sleep.
• 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.

The cream or pessary can sometimes be a bit messy, because it may leak slightly after application

• Wear a panty liner, so it catches any leakage and protects underwear.
• The pessary form of is generally less messy.

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.