Vaginally administered estrogens

Vaginally administered estrogens are estrogens that are delivered by intravaginal administration. Vaginally administered estrogens are thereby exerting their effects mainly in the nearby tissue, with more limited systemic effects compared to orally administered estrogens.^[1] It will not protect a woman against osteoporosis nor will it alleviate the hot flushes and hormonal imbalance caused by menopause.^[2]

Indications

Vaginally administered estrogen are usually used to treat some menopausal symptoms that are isolated to the vagina, vulva and urethra.^[3]

• Atrophic vaginitis, with presentations such as dryness and soreness in the vagina and dyspareunia (pain during sexual intercourse)^[1]
• Itching, redness, or soreness of the vulva^[1]
• Urinary urgency (feeling an urge to urinate more often than is needed), or dysuria (experiencing pain while urinating)^[4]

Forms

• Vaginal tablets, including Vagifem which contains estradiol^[5]
• Vaginal cream, including Premarin which is a compound cream^[6] consisting primarily of conjugated estrogens isolated from mare's urine. Another vaginal cream is Ovesterin, which contains estriol.
• Vaginal rings (such as Oestring), which are polymeric drug delivery devices designed to provide controlled release of drugs to the vagina over extended periods of time.

Side effects

Most of the vaginally administered estrogens are synthetic and therefore cause the following side effects^[7]

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:^[8]

• 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.

Breastfeeding Mothers

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.^[9]

Phytoestrogens are plant derived compounds found in a wide variety of foods. A litany of health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms.^[10] Plants such as Kacip Fatimah have been found to contain high quality phytoestrogen that could alleviate the symptoms of menopause.

References

1. Estrogen (Vaginal Route) from Mayo Clinic / Thomson Healthcare Inc. Portions of this document last updated: Nov. 1, 2011
2. "Estrogen (Vaginal Route) Before Using - Mayo Clinic". www.mayoclinic.org. Retrieved 2015-11-18.
3. Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, 20894 (2015-10-01). "Estrogen (Vaginal route)". mmddic/DDIC602127.
4. "Estrogen Vaginal Advanced Patient Information - Drugs.com". www.drugs.com. Retrieved 2015-11-18.
5. Vagifem - Manufacturer's website
6. Premarin (conjugated estrogens) Vaginal Cream - Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) -- November 2008
7. "Side Effects of Premarin Vaginal Cream (Conjugated Estrogens Vaginal Cream) Drug Center - RxList". RxList. Retrieved 2015-11-18.
8. "Estrogen Vaginal: MedlinePlus Drug Information". www.nlm.nih.gov. Retrieved 2015-11-18.
9. "Hormone Replacement Therapy | Endocrinologist Marina Johnson MD". Dr. Marina Johnson - The Institute of Endocrinology and Preventive Medicine in Dallas Texas. Retrieved 2015-11-18.
10. Patisaul, Heather B.; Jefferson, Wendy (2010-10-01). "The pros and cons of phytoestrogens". Frontiers in neuroendocrinology 31 (4): 400–419. doi:10.1016/j.yfrne.2010.03.003. ISSN 0091-3022. PMC 3074428. PMID 20347861.