Vaginal estrogen is a form of

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

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 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 may typically last from t ...

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 and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

vulva In mammals, the vulva (: vulvas or vulvae) comprises mostly external, visible structures of the female sex organ, genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, lab ...

and

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

. *

Atrophic vaginitis Atrophic vaginitis is inflammation of the vagina as a result of atrophy, tissue thinning due to low estrogen levels. Symptoms may include pain with sex, pain during penetrative sex, vaginal itchiness or dryness, and an urge to urinate or burning ...

, with presentations such as dryness and soreness in the vagina and

dyspareunia Dyspareunia ( ) is painful sexual intercourse due to somatic or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...

(pain during sexual intercourse) * Itching, redness, or soreness of the vulva * Urinary urgency (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 cl ...

(experiencing pain while urinating)

Forms

* Vaginal tablets, including Vagifem which contains

estradiol Estradiol (E2), also called oestrogen, oestradiol, is an estrogen steroid hormone and the major female sex hormone. It is involved in the regulation of female reproductive cycles such as estrous and menstrual cycles. Estradiol is responsible ...

* 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 th ...

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 many other animals. In placental mammals, urine flows from the Kidney (vertebrates), kidneys through the ureters to the urinary bladder and exits the urethra through the penile meatus (mal ...

. Another vaginal cream is Ovesterin, which contains estriol. *

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 ...

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

drug delivery Drug delivery involves various methods and technologies designed to transport pharmaceutical compounds to their target sites helping therapeutic effect. It involves principles related to drug preparation, route of administration, site-specif ...

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 women

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

birth defects A birth defect 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 range from mild to severe. Birth de ...

Breastfeeding

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

breast milk Breast milk (sometimes spelled as breastmilk) or mother's milk is milk produced by the mammary glands in the breasts of women. Breast milk is the primary source of nutrition for newborn infants, comprising fats, proteins, carbohydrates, and a var ...

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 (a type of estrogen produced by organisms other than humans) not generated within the endocrine system, but consumed by eating plants or manufactured foods. Also called a "dietary estrogen", it i ...

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