Estrogen Creams and Tablets

There are 3 common types of topical estrogen (put right in the vagina and on the external genitals​), available in Canada. These contain slightly different forms of estrogen hormones:

• Vagifem (contains estradiol) - tablet
• Estragyn (contains estrone) - cream
• Premarin (contains conjugated estrogens) - cream

These normally come in the form of a vaginal pellet (Vagifem) or cream (Premarin, Estragyn).

• Creams should be inserted into the vagina using an applicator and also rubbed on the external genitals (e.g., labia). Pellets inserted in the vagina with an applicator dissolve with body heat and moisture, but they often stay in the upper ⅔ of the vagina. If you have deep vaginal pain, this may be okay, but if you have pain at the opening of the vagina, you may find a cream works better for you.
• These treatments are usually used every day for the first 2 weeks, and then 2 times a day for another week—your healthcare provider will tell you what’s best for your symptoms.
• It usually takes 3 weeks before you’ll notice improvement. It can take 3 to 6 months for the full effect, but for some people it takes up to a year.
• Vagifem needs to be used with moisturizers or coconut oil to help the external genitals. Often topical estrogen is needed in addition to systemic estrogen replacement.

The Estring or Estradiol Ring

• If using vaginal moisturizers and lubricants for sex doesn’t make you more comfortable, think about using estrogen. Some women with hormone-sensitive cancers (e.g., breast cancer, uterine cancer) shouldn’t take estrogen. Estrogen may be okay for women who have other types of cancer that aren’t hormone-sensitive.
• Estring is estrogen replacement for the vagina. It’s put in the vagina, so it helps the vaginal tissue directly. Less estrogen is absorbed into the blood than with estrogen pills. This means Estring doesn’t affect the body as much and it has a much lower dose of estrogen.
• Estring is a vaginal ring (like the rim of a diaphragm) with a slow-release form of estrogen. You or your healthcare provider can put the ring in the upper part of the vagina. You wear it for 3 months and then it needs to be replaced. You wear it all the time (even for sex and activities).

Things to Think About

• Some vaginal discharge is common when using creams and this can help with lubrication for sex.
• Symptoms often return when you stop treatment, but it’s possible to switch from local estrogen to non-hormonal treatments like vaginal moisturizers. Some women with severe dryness may find non-hormonal treatments don’t work and may need to also use a short dose of topical estrogen for 1 to 3 months.
• There’s a small risk of thickened uterine lining, which isn’t a concern if you’ve had your uterus removed. Tell your healthcare provider if you have any unexpected vaginal bleeding. You need a prescription for these treatments and your doctor or healthcare provider will tell you about the risks and benefits of using them.
• If you’re using condoms or a diaphragm for birth control, creams can damage them, so tablets may be better to use. Talk to your healthcare provider about the form of birth control that’s best for you. The Centre for Sexuality​ is a good resource for more information about birth control options.
• The amount of estrogen in the low-dose Estring and Vagifem is enough to make the vagina more moist and stretchy, but not enough to affect other parts of the body (e.g., breast tissue). The Estring also comes in higher doses for other problems related to loss of estrogen (e.g., hot flashes, loss of bone density). However, when these products are used, the body is exposed to more estrogen.