Dr Gillian with a patient

Last Updated: October 19th 2024

What Are Topical Oestrogens?

Topical oestrogens are a type of hormone replacement therapy (HRT) applied directly to the vulva or vaginal area through creams, gels, pessaries, or small tablets. Unlike systemic HRT, which affects the whole body, these work locally and only small amounts enter the bloodstream. During the first few weeks, you might experience some side effects like breast tenderness or light spotting, but this usually settles once the tissues in the vaginal area have been restored with oestrogen. After that, hormone levels in the blood drop to almost undetectable levels, making topical HRT a safe option for most women, including some who’ve had breast cancer (in certain cases, check with your GP).

How Can Topical Oestrogens Help with Vaginal Symptoms?

As women approach menopause, one of the first noticeable symptoms is often vaginal discomfort, such as itching, soreness, or a constant “UTI” feeling. This happens because oestrogen levels start to decline, and the tissues in the vaginal area lose the oestrogen they need to stay healthy. Topical oestrogens help to replenish these levels.

Think of oestrogen like the mortar in a brick wall. When the mortar weakens, the wall (in this case, your vaginal lining) becomes less effective at keeping the natural flora in their right compartments and preventing irritation. By restoring oestrogen, you’re repairing that barrier and helping your body regain its natural balance, easing bladder irritation and discomfort along the way.

In my clinical experience, I’ve found that adding topical oestrogen can even boost sex drive in women who are already using standard HRT. It’s often the missing piece in making sex more comfortable again.

How to Use Topical Oestrogens?

There are several types of topical oestrogen treatments available in the UK. Finding the right one for you may take a bit of trial and error, but the key is finding the preparation that suits your body and symptoms best.

Most of these treatments start with a loading phase, where you use the product daily for a few weeks to build up oestrogen levels. After this, you’ll usually switch to a maintenance dose, using it just once or twice a week to keep symptoms at bay.

There are two main forms of topical oestrogens:

  • Estriol: A milder hormone that leaves the body quickly.
  • Oestradiol: A stronger hormone that stays in the body for longer.

UK Preparations for Topical Oestrogen

Oestradiol

  • Vaginal Pessaries/Tablets: These are inserted daily for 2–4 weeks, then tapered down to a maintenance dose. Brands include:
    • Gina (£1 per tablet), available over the counter.
    • Vagifem (£1.65 per tablet).
    • Vagirux (£1.65 per tablet).
  • Vaginal Ring (Estring): This ring is inserted into the vagina and left for three months, delivering a continuous low dose of oestrogen. It’s particularly effective for bladder symptoms and mild prolapse. Cost: £40–£50.

Oestriol

  • Ovestin Cream: A popular option, with 500 micrograms of estriol per application.
  • Blissel Gel: Contains 50 micrograms of estriol.
  • Imvaggis Pessary: Ultra-low dose pessary with 30 micrograms of estriol.

The price per application of the estriol preparations is about £1. During the first three months, you’ll use around 50 doses for both oestriol and oestradiol preparations. Most women then continue with one or two doses per week, meaning the ongoing cost is around £4–£8 a month.

If one preparation doesn’t suit you, it’s worth trying another. Many women react to the other ingredients rather than the active hormone itself, so trying a different brand can make a big difference.

Are There Alternatives to Topical Oestrogens?

Maintaining vaginal health isn’t just about oestrogen—regular use of vaginal moisturisers is important too. Check out my blog on vaginal moisturisers for more tips on keeping things comfortable “Down There.”

There are also some alternative hormonal treatments worth considering, though they aren’t backed by as much research:

  • Intrarosa: A precursor to testosterone, which your vaginal cells convert into oestradiol. It’s a more expensive option, and studies haven’t shown it to be particularly effective yet.
  • Ospemiphene (Senshio): An oral tablet that helps vaginal cells retain oestrogen. It’s ideal for women who can’t insert anything into the vagina, but there’s not enough evidence yet to recommend it for women recovering from breast cancer.

What to Expect When Using Topical Oestrogens?

Most women don’t notice an immediate improvement. It typically takes around 4–6 weeks for symptoms like vaginal dryness, irritation, and discomfort to start easing. Full effect can take up to a year, but many women feel significantly better within three months.

You may experience some mild side effects at first, such as light vaginal bleeding, breast tenderness, or cramping. This should settle after the initial phase. If bleeding continues beyond the first few weeks, it’s important to speak to your GP for further evaluation.

How Long Can I Use Topical Oestrogens?

You can continue using topical oestrogens for as long as they’re helping manage your symptoms. Some women may only need a monthly top-up, while others might require a more regular dose, such as once or twice a week. The key is finding what works best for your body and lifestyle.

If you have any questions or want to discuss whether topical oestrogens are right for you, feel free to get in touch!

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