Vaginal estrogen is a form of

estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal ac ...

that is delivered by

intravaginal administration Intravaginal administration is a route of administration where the substance is applied inside the vagina. Pharmacologically, it has the potential advantage to result in effects primarily in the vagina or nearby structures (such as the vaginal po ...

. Vaginally administered estrogens are thereby exerting their effects mainly in the nearby tissue, with more limited systemic effects compared to orally administered estrogens.Estrogen (Vaginal Route)
from Mayo Clinic / Thomson Healthcare Inc. Portions of this document last updated: Nov. 1, 2011 It will not protect against osteoporosis. With perhaps the exception of the Femring, it also will not alleviate the

hot flash Hot flashes (also known as hot flushes) are a form of flushing, often caused by the changing hormone levels that are characteristic of menopause. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and ...

es and hormonal imbalance caused by menopause.

Indications

Vaginally administered estrogen are usually used to treat some menopausal symptoms that are isolated to the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...

and

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ...

. *

Atrophic vaginitis Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to not enough estrogen. Symptoms may include pain with sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does ...

, with presentations such as dryness and soreness in the vagina and dyspareunia (pain during sexual intercourse) * Itching, redness, or soreness of the vulva *

Urinary urgency Urination, also known as micturition, is the release of urine from the urinary bladder through the urethra to the outside of the body. It is the urinary system's form of excretion. It is also known medically as micturition, voiding, uresis, ...

(feeling an urge to urinate more often than is needed), or

dysuria Dysuria refers to painful or uncomfortable urination. It is one of a constellation of ''irritative'' bladder symptoms (also sometimes referred to as lower urinary tract symptoms), which includes nocturia and urinary frequency. Diagnosis The c ...

(experiencing pain while urinating)

Forms

* Vaginal tablets, including Vagifem which contains

estradiol Estradiol (E2), also spelled oestradiol, is an estrogen steroid hormone and the major female sex hormone. It is involved in the regulation of the estrous and menstrual female reproductive cycles. Estradiol is responsible for the development o ...

* Vaginal creams, including

Premarin Conjugated estrogens (CEs), or conjugated equine estrogens (CEEs), sold under the brand name Premarin among others, is an estrogen medication which is used in menopausal hormone therapy and for various other indications. It is a mixture of the ...

which is a compound cream consisting primarily of conjugated

s isolated from mare's

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellular ...

. Another vaginal cream is Ovesterin, which contains

estriol Estriol (E3), also spelled oestriol, is a steroid, a weak estrogen, and a minor female sex hormone. It is one of three major endogenous estrogens, the others being estradiol and estrone. Levels of estriol in women who are not pregnant are almost ...

. *

Vaginal ring Vaginal rings (also known as intravaginal rings, or V-Rings) are polymeric drug delivery devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the vagina a ...

s (such as ''Oestring''), which are polymeric

drug delivery Drug delivery refers to approaches, formulations, manufacturing techniques, storage systems, and technologies involved in transporting a pharmaceutical compound to its target site to achieve a desired therapeutic effect. Principles related to dr ...

devices designed to provide controlled release of drugs to the

over extended periods of time. Although the Femring might be able to ease hot flashes, this does not appear to be the case for other vaginal estrogen rings or vaginal creams.

Side effects

Most of the vaginally administered estrogens are synthetic and therefore cause the following side effects Serious side effects: * chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; * sudden numbness or weakness, especially on one side of the body; * sudden severe headache, confusion, problems with vision, speech, or balance; * pain, swelling, warmth, or redness in one or both legs; * abnormal vaginal bleeding; * migraine headache; * pain, swelling, or tenderness in your stomach; * confusion, problems with memory or concentration; * jaundice (yellowing of the skin or eyes); * swelling in your hands, ankles, or feet; or * a breast lump. Less serious side effects may include: * mild nausea, vomiting, bloating, stomach cramps; * breast pain, tenderness, or swelling; * freckles or darkening of facial skin; * increased hair growth, loss of scalp hair; * changes in weight or appetite; * problems with contact lenses; * vaginal itching or discharge; * changes in your menstrual periods, decreased sex drive; or * headache, nervousness, dizziness, tired feeling.

Contraindications

Estrogen administered vaginally should not be given to persons who are:

Pregnant people

Estrogen should not be used while pregnant as it could cause serious

birth defects A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

Breastfeeding

Estrogen passes into the breast milk and will cause a decrease in the production and quality of breast milk.

Alternatives

To effectively alleviate the symptoms of menopause, it is best to take oral estrogen instead of topical estrogen since the results are systemic and it will rejuvenate the entire reproductive system and not just the perineal area.

Phytoestrogens A phytoestrogen is a plant-derived xenoestrogen (see estrogen) not generated within the endocrine system, but consumed by eating plants or manufactured foods. Also called a "dietary estrogen", it is a diverse group of naturally occurring nonster ...

are plant derived compounds found in a wide variety of foods. Several health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms are frequently attributed to phytoestrogens but many are also considered to have the potential to cause adverse health effects. Plants such as Kacip Fatimah have been found to contain phytoestrogens that could alleviate some symptoms of menopause.

References

{{Estrogens and antiestrogens Estrogens Menopause