Vaginal Estrogen

Aka: Vaginal Estrogen, Topical Estrogen, Estrogen Vaginal Preparation, Estradiol Vaginal Ring, Estrogen Ring, FemRing, Estring, Estradiol Vaginal Tablet, Vagifem, Estrogen Cream, Premarin Cream, Estrace Cream

1. See Also
   1. Menopause
   2. Estrogen Replacement
   3. Continuous Estrogen Replacement
   4. Sequential Estrogen Replacement
   5. Transdermal Estrogen
2. Indications
   1. Atrophic Vaginitis in Menopause
3. Preparations
   1. Estradiol acetate vaginal ring (FemRing)
      1. Placed in vagina and replaced every 90 days
      2. Available as 0.05 and 0.1 mg/day rings
      3. Requires opposing Progesterone supplement if Uterus intact
   2. Estradiol Vaginal Ring (Estring)
      1. Placed in vagina and replaced every 90 days
      2. Available as 2 mg rings (releases 7.5 mcg estradiol per day)
   3. Estradiol Vaginal Tablet (Vagifem)
      1. Initial: One tablet intravaginally daily for 2 weeks
      2. Later: One tablet intravaginally twice weekly
      3. Available in 10 mcg and 25 mcg applicators
      4. May be safe at low dose, low frequency use despite history of Breast Cancer
         1. Low systemic absorption at low dose
         2. Requires informed consent regarding potential risks and lack of safety studies following Breast Cancer
         3. Pruthi (2012) Mayo POIM Conference, Rochester
   4. Estrogen Cream (Premarin or Estrace Creams)
      1. Premarin applied 0.5 to 2 grams daily
      2. Estrace applied 2-4 grams for 2 weeks, then reduced (0.1 mg estradiol per gram cream)