If using vaginal moisturizers and lubricants for sex doesn’t make you more comfortable, think about using estrogen. If you have a hormone-sensitive cancer (like breast cancer or uterine cancer), using estrogen may not be recommended. Talk with your healthcare provider about using estrogen.
Estrogen creams and tablets
Topical estrogen is hormone that you put right in your vagina and on the
external genitals. It normally comes in the form of a tablet (vaginal pellet) or cream. There are 3 common types of topical estrogen available in Canada. They have slightly different forms of estrogen hormones:
- Vagifem (contains estradiol) – tablet (Vagifem needs to be used with moisturizers or coconut oil to help the external genitals.)
- Estragyn (contains estrone) - cream
- Premarin (contains conjugated estrogens) - cream
Creams should be inserted into the vagina using an applicator and also rubbed on the external genitals, like the labia. If you're using condoms or a diaphragm for birth control, creams can damage them, so tablets may be better to use. Talk to your healthcare provider about the form of
birth control that's best for you. Some vaginal discharge is common when using creams and this can help with lubrication for sex.
Tablets should be inserted in the vagina with an applicator. They dissolve with body heat and moisture, but they often stay in the upper ⅔ of the vagina. If you have deep vaginal pain, this may be OK, but if you have pain at the opening of your vagina, you may find a cream works better for you.
Estrogen creams and tablets are usually used every day for the first 2 weeks, and then 2 times a day for another week. Your healthcare provider will tell you what’s best for your symptoms. It usually takes 3 weeks before you’ll notice improvement in your symptoms. It can take 3 to 6 months for the full effect, but for some people it takes up to a year. Often, topical estrogen is needed in addition to systemic estrogen replacement.
Estring (estradiol ring)
Estring is estrogen replacement for the vagina. It’s a ring that is put in the vagina, like the rim of a diaphragm, so it helps the vaginal tissue directly. The ring has a slow-release form of estrogen. You absorb less estrogen into your blood through the ring than with estrogen pills. This means Estring doesn’t affect your body as much and it has a much lower dose of estrogen.
You or your healthcare provider can put in the ring. It goes in the upper part of your vagina. You wear the ring all the time, even for sex and activities. You wear it for 3 months and then it needs to be replaced.
Things to think about when using estrogen treatments
- You need a prescription for these treatments and your doctor or healthcare provider will tell you about the risks and benefits of using them.
- Symptoms often return when you stop treatment, but it's possible to switch from local estrogen to non-hormonal treatments like vaginal moisturizers. If you have severe vaginal dryness, you may find non-hormonal treatments don't work, and you may also need to use a short dose of topical estrogen for 1 to 3 months
- There's a small risk of having a thickened uterine lining. This isn't a concern if you've had your uterus removed. Tell your healthcare provider if you have any unexpected vaginal bleeding.
- The amount of estrogen in the low-dose Estring and Vagifem is enough to make the vagina moister and stretchier, but not enough to affect other parts of your body, like your breast tissue. The Estring also comes in higher doses for other problems related to loss of estrogen like hot flashes and loss of bone density. When these higher-dose products are used, your body is exposed to more estrogen.
