Estriol Cream is a gentle yet effective topical solution designed to alleviate symptoms of menopause, such as dryness and thinning of the vaginal tissues. Formulated with natural Estriol, this hormone-based cream supports and restores feminine health by promoting collagen production and increasing elasticity. Ideal for daily use, Estriol Cream provides a soothing, moisturizing effect with minimal side effects, making it a preferred choice for women seeking a natural approach to menopausal comfort. Easy to apply and free from harsh chemicals, it’s the perfect addition to your wellness routine, ensuring you feel your best every day.
Dr Sarah Thornton MbChB, Coaching Academy diploma with distinction
GP, Medical coach
What is Estriol cream?
Estriol cream is a topical hormone therapy used primarily to alleviate symptoms associated with menopause, such as vaginal dryness, itching, and irritation. Estriol is a type of estrogen, one of the three main estrogens naturally produced by the body. Unlike other forms of estrogen, estriol is considered a weaker estrogen, making it a popular choice for localized treatment with fewer systemic effects.
When applied to the vaginal area, estriol cream helps to restore the natural pH balance, improve the thickness and elasticity of vaginal tissues, and enhance moisture levels. This can relieve discomfort and improve overall vaginal health. Some formulations are also used to help with urinary symptoms like frequent urination or urinary urgency.
Because it is used topically, estriol cream generally has a lower risk of side effects compared to oral or systemic hormone replacement therapies. However, it should be used under the guidance of a healthcare professional, especially for women with a history of hormone-sensitive conditions like certain types of breast cancer.
What is the active ingredient in Estriol cream?
The active ingredient in Estriol Cream: Estriol
What is Estriol cream used for?
Estriol 1mg/g cream, contains a hormone known as estriol. This product is classified under Hormone Replacement Therapy (HRT) and is primarily used to treat symptoms of menopause in the vagina, such as dryness and irritation, a condition medically referred to as vaginal atrophy. Vaginal atrophy arises from decreased estrogen levels, a natural change following menopause.
Estriol 1mg/g cream functions by substituting the estrogen normally produced in women's ovaries. The cream is applied directly inside the vagina, allowing the hormone to act precisely where it's needed to alleviate discomfort.
As women age, their ovaries gradually reduce estrogen production:
This reduction is typical at menopause, which usually occurs around age 50.
If the ovaries are surgically removed before menopause, estrogen production ceases abruptly.
A lack of estrogen can lead to thinning and drying of the vaginal wall, making sexual intercourse painful and increasing the risk of vaginal infections. Estriol 1mg/g cream, which supplements estrogen, can help mitigate these issues. Improvements may be noticed after several days or weeks of use.
Additionally, this cream is utilized:
To facilitate wound healing before or after vaginal surgery.
How does Estriol cream work?
Estriol cream works by delivering a form of estrogen directly to the vaginal area, which helps alleviate symptoms associated with low estrogen levels, such as those occurring during menopause. Here’s a breakdown of how it functions:
Hormone Replacement: Estriol is a mild form of estrogen. When applied as a cream, it replaces some of the estrogen that the body no longer produces naturally after menopause. This local application helps minimize systemic absorption and focuses the effect where it's needed most.
Tissue Regeneration: Estrogen plays a crucial role in maintaining the health and elasticity of vaginal tissues. By applying estriol cream directly to the vagina, it helps stimulate the regeneration of the vaginal tissue and increases the blood flow to this area. This results in thicker, healthier vaginal walls and increased natural lubrication.
Alleviation of Symptoms: The cream helps relieve common symptoms of vaginal atrophy, such as dryness, itching, burning, and discomfort during intercourse. It does this by enhancing the moisture content of the vaginal lining and making the tissue less fragile.
Restoration of pH Balance: Estrogen helps maintain the natural acidity of the vagina, which is important for its self-cleaning mechanism and preventing infections. Estriol cream helps restore this pH balance, reducing the risk of bacterial and fungal infections.
By targeting the delivery of estrogen directly to the vaginal area, estriol cream effectively treats symptoms with fewer systemic effects compared to oral hormone replacement therapies. This localized approach makes it a preferred choice for those seeking relief from menopausal changes in the vaginal environment.
How do you use Estriol cream?
Always follow your doctor's or pharmacist's instructions precisely when using this medication. If you have any uncertainties, consult with them for clarification.
If you have had a hysterectomy (removal of the womb) and ovaries, you can begin using this medication immediately.
If you are new to Hormone Replacement Therapy (HRT) or transitioning from a period-free HRT, you can also start using this medication right away.
If switching from another type of HRT that includes menstrual periods, begin using this medication one week after finishing your current treatment.
Dosage Instructions:
For vaginal symptoms, typically apply 1 applicator (up to the ring, containing 0.5 mg estriol in 0.5 g of cream) daily for the first 2 to 3 weeks, up to a maximum of 4 weeks.
Subsequently, reduce to 1 applicator (up to the ring) twice weekly. Your doctor will prescribe the lowest effective dose to relieve symptoms, occasionally recommending breaks (every 2 to 3 months for 4 weeks) to assess ongoing necessity.
Before or after vaginal surgery:
Before surgery, use 1 applicator (up to the ring) daily for 2 weeks preceding the operation.
After surgery, refrain from using the cream for at least 2 weeks. Resume with 1 applicator (up to the ring) twice weekly thereafter.
Application Method:
This medication includes a clear plastic applicator. Use it to administer the cream into the vagina, ideally before bedtime.
The applicator is marked with a ring; fill it to this mark with the cream for the correct dose.
Instructions:
Remove the tube cap and invert it to puncture the tube's seal.
Attach the applicator's end to the tube and squeeze the tube to fill the applicator up to the red ring mark (the plunger halts at this mark).
Detach the applicator from the tube and replace the tube cap.
To apply the cream, recline, insert the applicator deeply into the vagina, and gradually push the plunger fully.
Cleaning the Applicator:
After each use, remove the plunger from the barrel and wash both components in lukewarm, soapy water. Avoid using detergents and do not boil the applicator. Rinse thoroughly with clean water.
In case of overdose or accidental ingestion:
If excessive cream is applied or swallowed accidentally, contact your doctor immediately. Symptoms may include nausea, vomiting, or vaginal bleeding.
If a dose is missed:
Apply the missed dose as soon as remembered, unless more than 12 hours late. Skip the missed dose if over 12 hours late.
Discontinuation:
Continue using this medication as directed by your doctor. Even if symptoms improve, premature cessation may cause symptoms to recur.
Who should not use Estriol cream?
Medical history and regular check-ups
Using Hormone Replacement Therapy (HRT) involves risks that must be weighed when deciding whether to start or continue the treatment.
There is limited experience in treating women who experience premature menopause due to ovarian failure or surgery. If you fall into this category, the risks associated with HRT may differ; please discuss this with your doctor.
Before you begin or resume HRT, your doctor will review your personal and family medical history and may conduct a physical examination. This could include checking your breasts and possibly an internal examination if deemed necessary.
After starting HRT, make sure to visit your doctor for regular check-ups, at least annually, to evaluate the benefits and risks of continuing the treatment. It's also important to attend regular breast screenings as recommended by your doctor.
Do not use this medicine If:
You currently have, have had, or are suspected of having breast cancer.
You have or are suspected of having cancer that is estrogen-sensitive, such as endometrial cancer.
You experience unexplained vaginal bleeding.
You have untreated endometrial hyperplasia (excessive thickening of the womb lining).
You have or have had a blood clot in a vein, such as deep venous thrombosis or pulmonary embolism.
You have a clotting disorder (e.g., deficiencies in protein C, protein S, or antithrombin).
You have or recently had a disease caused by blood clots in the arteries, like a heart attack, stroke, or angina.
You have had liver disease and your liver function tests have not normalized.
You have inherited porphyria.
You are allergic to estriol or any other ingredients of this medicine.
If any of these conditions arise while using HRT, stop immediately and consult your doctor.
Warnings and precautions:
Inform your doctor if you've had any of the following, as these conditions may reoccur or worsen under HRT:
Uterine fibroids
Endometriosis or a history of endometrial hyperplasia
A heightened risk of blood clots or estrogen-sensitive cancers
High blood pressure, liver disorders, diabetes, gallstones
Migraines, severe headaches, systemic lupus erythematosus (SLE), epilepsy, asthma
Otosclerosis (a hearing condition), fluid retention related to heart or kidney issues, angioedema
Also, notify your doctor if you are being treated with the drug combination ombitasvir/paritaprevir/ritonavir, with or without dasabuvir for Hepatitis C, as interactions with estrogen-containing products can increase liver enzyme levels.
This medicine contains cetyl and stearyl alcohol, which may cause skin reactions like contact dermatitis.
Immediate medical attention required if:
You develop any conditions listed under “Do Not Use This Medicine.”
You experience symptoms like jaundice, which may indicate liver disease.
You encounter swollen face, tongue and/or throat, difficulty swallowing, or breathing issues suggestive of angioedema.
You have a significant increase in blood pressure, new migraine-like headaches, or if you become pregnant.
You observe symptoms of a blood clot, such as leg pain and redness, sudden chest pain, or breathing difficulties.
Remember, Estriol 1mg/g cream is not a contraceptive. If it has been less than 12 months since your last menstrual period or you are under 50 years old, you might need additional contraception to prevent pregnancy. Discuss your options with your doctor.
HRT and cancer risks
Endometrial Hyperplasia and Cancer: Long-term use of estrogen-only HRT tablets can elevate the risk of endometrial hyperplasia and cancer of the womb lining (endometrium). While it is unclear if the same risk applies to this medicine when used repeatedly or for long periods (over one year), it has been noted that this medicine has very low blood absorption, which generally eliminates the need for adding a progestogen.
If you experience any bleeding or spotting, it's typically not a cause for alarm, but you should schedule a visit with your doctor as it may indicate thickening of the endometrium.
Local vs. Systemic Treatment: This medicine is designed for local application in the vagina and is minimally absorbed into the bloodstream. This significantly reduces the likelihood that the following conditions will worsen or recur during treatment. Nonetheless, if you have concerns, consulting your doctor is advisable.
Breast Cancer: Current evidence indicates that using this medicine does not increase the risk of breast cancer in women who have never had the disease. However, its safety in women who have previously had breast cancer remains undetermined.
It's important to regularly examine your breasts and report any noticeable changes to your doctor, such as:
Dimpling of the skin
Changes in the nipple
Any visible or palpable lumps
Additionally, participating in mammography screening programs as recommended is strongly advised.
Ovarian cancer and HRT
Ovarian cancer is significantly less common than breast cancer, but it's important to note that using estrogen-only HRT has been linked to a slightly increased risk of developing ovarian cancer.
The likelihood of developing ovarian cancer depends on age. For instance, among women aged 50 to 54 who do not use HRT, approximately 2 in 2000 will be diagnosed with ovarian cancer within five years. In contrast, among women who have been using HRT for five years, the rate increases to about 3 in 2000, indicating about 1 additional case per 2000 users.
Impact of HRT on heart and circulation
Blood Clots in a Vein (Thrombosis): The risk of developing blood clots in the veins for HRT users is approximately 1.3 to 3 times higher than for non-users, particularly within the first year of use. Blood clots can be severe; if one travels to the lungs, it may lead to chest pain, breathlessness, fainting, or even death.
The likelihood of experiencing a venous blood clot increases with age and certain conditions. Make sure to inform your doctor if any of the following apply to you:
You are immobilized for an extended period due to major surgery, injury, or illness (refer to the relevant section on surgery).
You are significantly overweight (BMI greater than 30 kg/m²).
You have a blood clotting disorder requiring ongoing anticoagulant therapy.
A close family member has had a blood clot in the leg, lung, or another organ.
You have systemic lupus erythematosus (SLE).
You have cancer.
For symptoms indicating a blood clot, refer to the guidelines on when to discontinue this medicine and seek immediate medical attention.
Comparison of health risks with HRT
Blood Clots in Veins: Among women in their 50s who do not use HRT, approximately 4 to 7 out of 1000 are expected to develop a blood clot in a vein over a five-year period. In contrast, for women in the same age group who have been using estrogen-only HRT for more than five years, the incidence increases slightly to 5 to 8 out of 1000 users, indicating about one additional case per 1000 users.
Heart Disease: For women undergoing estrogen-only therapy, there is no increased risk of heart disease associated with the treatment.
Stroke: The risk of stroke is approximately 1.5 times higher for HRT users compared to non-users, with the number of additional stroke cases increasing with age. Observationally, among women in their 50s who are not on HRT, about 8 in 1000 are expected to experience a stroke over a five-year span. For women in their 50s using HRT, this figure rises to 11 out of 1000 users over the same period, thus accounting for an additional three cases.
Other Conditions: HRT does not prevent memory loss. There is some evidence suggesting an increased risk of memory loss in women who begin HRT after the age of 65. Consult your doctor for more personalized advice.
Surgical Procedures Inform your doctor if you are using this medication and are scheduled for surgery. It may be necessary to discontinue HRT approximately 4 to 6 weeks prior to surgery to minimize the risk of blood clots. Your doctor will advise when it is safe to resume HRT after the operation.
Pregnancy and Breastfeeding This medication is intended only for postmenopausal women. If you become pregnant while taking this medicine, discontinue its use immediately and contact your doctor.
Avoid using this medication if you are pregnant or could become pregnant, as it could harm the baby.
Do not breastfeed while using this medicine.
Always consult your doctor or pharmacist before taking any medication if you are pregnant or breastfeeding.
Driving and Operating Machinery This medication should not affect your ability to drive or operate machinery.
What are the side effects with Estriol cream?
As with all medications, this treatment may cause side effects, though not everyone will experience them. Certain conditions, such as ovarian cancer, blood clots in the legs or lungs (venous thromboembolism), stroke, and potential memory loss (if HRT is started after age 65), are reported more often in women using hormone replacement therapy (HRT) that circulates in the bloodstream. These risks are significantly lower with vaginally applied treatments like this one.
Contact your doctor immediately if you experience any of the following serious side effects, as they may stop your treatment:
Increased blood pressure
Yellowing of the skin or eyes (jaundice)
Sudden migraine-like headaches
Signs of blood clots
These side effects are rare. Other possible side effects include vaginal irritation, increased discharge, gallbladder issues, skin reactions, breast tenderness, headaches, nausea, and flu-like symptoms. If any side effects worsen or aren't listed, consult your doctor or pharmacist.
Other side effects reported with different hormone replacement therapies (HRTs) include:
Gallbladder disease
Various skin conditions, such as:
Skin discoloration on the face or neck (chloasma)
Painful, red skin nodules (erythema nodosum)
Rash with target-shaped redness or sores (erythema multiforme)
If you experience any side effects, including those not listed in this leaflet, contact your doctor or pharmacist for further guidance.
Reporting Side Effects
If you experience any side effects, including those not mentioned in this leaflet, consult your doctor or pharmacist. You can also report side effects through the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or by searching for "MHRA Yellow Card" in the Google Play or Apple App Store. Reporting side effects helps improve safety information for this medication.
Does Estriol cream interact with other medicines?
Please inform your doctor or pharmacist if you are taking, or have recently taken, any other medicines, including over-the-counter medications, herbal remedies, or other natural products. This is important as this medicine can interact with other medicines, potentially altering how they or this medicine works.
Specifically, let your doctor or pharmacist know if you are taking any of the following:
Medications for epilepsy, such as barbiturates, hydantoins, and carbamazepine.
Medications for treating infections, such as griseofulvin and rifamycins.
Medications for viral infections, including nevirapine, efavirenz, ritonavir, or nelfinavir.
Herbal preparations containing St. John’s Wort, which is commonly used to treat depression.
Any of the following: corticosteroids, succinylcholine, theophyllines, or troleandomycin.
If you have Hepatitis C and are taking the combination treatment of ombitasvir, paritaprevir, ritonavir, with or without dasabuvir, please notify your doctor. This combination can interact with estrogen-containing products, potentially causing increases in liver enzyme levels; the risk with this particular medicine is not yet known.
If you are uncertain whether any of the above information applies to you, consult your doctor or pharmacist before using this medicine.
Frequently asked questions
What is Estriol Cream?
Estriol Cream is a type of Hormone Replacement Therapy (HRT) containing Estriol, a form of estrogen. It is designed specifically to alleviate symptoms like vaginal dryness or vaginal atrophy that many women experience during menopause. Applied directly inside the vagina using a reusable applicator, Estriol Cream helps maintain hydration and soothe the vaginal area by mimicking the estrogen previously produced by the ovaries.
What are the uses of Estriol cream?
Estriol cream is primarily used to treat symptoms of vaginal dryness and vaginal atrophy in menopausal women. These symptoms can include soreness, itchiness, pain during intercourse, frequent urination, and recurring urinary tract infections. The cream is also used to promote healing following vaginal surgery.
How does Estriol cream work?
Estriol cream works by supplementing the body's estrogen levels directly at the site of discomfort. It is applied directly into the vagina, allowing the estrogen to be absorbed where it is most needed. This targeted approach provides quick relief from menopausal symptoms while minimizing the risk of side effects commonly associated with systemic HRT.
How long does it take for Estriol cream to work?
Most women begin to notice improvements in their symptoms within 2 to 3 weeks of daily application. If symptoms do not improve within 4 weeks, it is advisable to consult a doctor.
Does Estriol cream cause weight gain?
There is no substantial evidence linking Estriol Cream with weight gain. Some women might experience fluid retention, which can cause bloating, but this typically improves within the first few months of treatment.
Are there any alternatives to Estriol cream?
Yes, alternatives include Vagifem, which comes as tablets or pessaries, and various non-hormonal vaginal lubricants and moisturizers. Other forms of prescription HRT, such as oral medications and skin patches, are also available.
What is the dosage of Estriol cream?
For treating vaginal dryness, apply one applicator filled to the red ring mark (0.5 mg) once daily for 2-3 weeks. After this period, reduce the application to twice a week.
How should Estriol cream be applied?
The best time to apply Estriol Cream is before bedtime. To use, pierce the tube with the cap's point, attach the applicator, and fill it with cream up to the red ring mark by squeezing the tube. Insert the applicator deeply into the vagina and then push the plunger. Afterwards, clean the applicator with hot soapy water.
How to discontinue Estriol cream?
Consult your doctor before stopping the use of Estriol Cream. Your doctor can discuss the effects of discontinuation and potential further treatment options.
What are the ingredients in Estriol cream?
The active ingredient is Estriol. Other ingredients include chlorhexidine dihydrochloride, octyldodecanol, cetyl palmitate, glycerin, cetyl alcohol, stearyl alcohol, polysorbate 60, sorbitan stearate, lactic acid, sodium hydroxide, and purified water.
What are the side effects of Estriol cream?
Common side effects include irritation or itching around the vagina, headaches, breast tenderness, stomach pain, nausea, vaginal bleeding or discharge, and flu-like symptoms. Consult a doctor if these persist or worsen.
Are there any warnings associated with Estriol cream?
Do not use Estriol Cream if you have unexplained vaginal bleeding, liver disease, a history of breast cancer or other estrogen-sensitive cancers, or if you have had a blood clot or clotting disorder. Discuss any pre-existing conditions like asthma, epilepsy, or diabetes with your doctor before using Estriol Cream.
What about Estriol cream and cancer?
While estrogen-only HRT taken orally can increase the risk of certain cancers, the risk is considered lower with Estriol Cream due to its minimal systemic absorption.
Can Estriol cream cause blood clots?
Using any HRT can slightly increase the risk of blood clots. Immediate medical attention should be sought if symptoms indicative of a blood clot occur.
Is Estriol cream safe during pregnancy and breastfeeding?
Estriol Cream is only for postmenopausal women and is not a contraceptive. It should not be used if you are pregnant or breastfeeding. Discuss contraceptive options with your doctor if necessary.
