Oestrogen vaginal cream and pessaries

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

Applying oestrogen directly to your 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 your breast or uterus.
• It's safe to use if you've had 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 healthcare provider about whether it's 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 it's 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 a special applicator 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 your finger into your vagina.
• To clean the applicator, pull the plunger down and wash it in warm (not boiling), soapy water. Don't 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 1 day.

Vaginal pessaries

• Vaginal pessaries are inserted into your vagina. They're 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 1 pessary from its wrapper. Either using a squatting position or lying on your back or side, insert the pessary deeply into your 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 1 day.

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

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

Sexual intercourse

• If you're using Ovestin vaginal cream it's fine to have sex afterwards but it may be more messy as the cream melts. You could use a condom if this bothers you. 
• If you're using a pessary it's best to avoid intercourse on the night of, or morning after, inserting it. However it's not a problem if it does happen. If you know you're going to be having intercourse, skip the pessary and use it the next night instead. If it's during the 2 weeks where you're using one every night, just add another night on the end.
• Note: There are no safety concerns of oestrogen transfer to your partner. 

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

Some people may get vaginal itching or burning. This can happen when you first start using oestrogen vaginal and usually settles within 2 weeks. Tell your healthcare provider if it bothers you.