I’m using vaginal oestrogen – does it have the same risks as HRT?

I often meet women in my clinic who have been prescribed vaginal oestrogen, either in the form of a vaginal tablet or cream, but are not actually using it because they are worried after reading the patient information leaflet contained in the box.

Theoretically these vaginal treatments are a form of HRT as they contain the hormone oestrogen. Therefore the information leaflet contains all the same warnings that are found in the leaflets of all forms of HRT. However, the vast majority of these warnings and risks are not relevant to vaginal oestrogen as so little of it is absorbed into the body. In fact, it has been stated that you would need to use the vaginal treatment every day for a whole year to get the same dose as a single tablet of oral HRT! Most women will only use it 2-3 times a week, so they are getting an even smaller dose.

My advice to women is that vaginal oestrogen is hugely effective at treating vaginal symptoms associated with menopause – symptoms such as vaginal dryness, pain when having sex, and troublesome urinary symptoms – and it is really safe to use. It can be used on its own if these are the only symptoms you have, or in combination with other HRT if you have generalised symptoms too.

I have recently been asked if using vaginal oestrogen after the age of 65 requires any monitoring, such as additional smear tests. This is not needed. In fact, using it before this age can make smear tests more comfortable, and you can then continue to use it long term afterwards!

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