Is vaginal estrogen for you?

Visiting us at PFI comes with a few guarantees: You will be greeted by our receptionist when you arrive; You will see one of our skilled providers at your first visit; and we will do our best to send you home with a better understanding of your medical concern and the treatment available.


However, what will vary are the specifics. You may need to come back in for up to four additional tests. You may need to have imaging done prior to your next appointment. You may need surgery, or you may just need physical therapy. But the most relevant “may” today is a prescription for vaginal estrogen.


At your appointment, the doctor may determine that vaginal estrogen is in your best interest. And if that is the case, he’ll likely send a prescription to your pharmacy for one or another of the brands of vaginal estrogen. 


You are likely familiar with at least one of these names: Estrace, Premarin, Estradiol, etc. But don’t worry if you aren’t. They are all comparable products, with a few differences to accommodate allergic restrictions. However, patients call us with a few common questions that can be just as easily answered here without having to wait for us to call back or summon a nurse.  

To begin with: all vaginal estrogen was not created equal. The three most common forms of vaginal estrogen are 1) a ring that must be replaced by a medical professional about every 90 days, 2) a pill that is inserted into the vagina, and 3) a vaginal cream. At PFI, we typically prescribe the cream because the pill is often too-low a dose to achieve the outcome we look for.


When you start the cream, we recommend that you insert it at bedtime because of the risk of leaking should you stand right away. The nurse or the doctor will provide details on how often you should use the product, but in case you forget or misplace your instructions, we recommend using the product every night for two weeks and then three times per week thereafter.


A word of warning: the cream is messy. We know it is messy, but the benefits outweigh the inconvenience of remembering to insert the cream at bedtime. Please call the office with any concerns.


If you have used the product in the past and only stopped for a short time, perhaps a few weeks, we recommend that you begin with the initial two-week loading dose again, outlined above. If you have questions, please do not hesitate to call the office and speak to a nurse.


And then the question arises: how long do I need to use the vaginal estrogen? This, like so many elements of your health, varies. However, for most women, the answer is: use the product as long as you want to reap the benefits. 


The doctor can determine whether you need to take the product continuously or whether a few months out of the year would suffice. But please consult your doctor if you plan to or wish to stop use vaginal estrogen altogether.



But what are the benefits of vaginal estrogen? Why take it just because the doctor said so? Well, the intended use of vaginal estrogen is restoration of the vaginal tissue, which relieves a lot of painful vaginal dryness. It encourages growth of good bacteria that allows your vagina to be that “self-cleaning oven” we’ve all heard used as the metaphor. And that good bacteria resists the bad bacteria to prevent bladder infections.


Vaginal estrogen also has an effect on the bladder. In some patients, vaginal estrogen can improve urinary incontinence symptoms, as well as other related issues, such as bladder spasms. You should be able to see those results after about 6-8 weeks.


But how do you know whether you need vaginal estrogen at all? That also, like so many things, varies. However, the doctor will listen to you and examine you at the first visit to determine whether vaginal estrogen will be of any benefit to you. If you weren’t prescribed vaginal estrogen or have run out, please call and notify us in the office. 

 

Now, a word on the difference between the types of estrogen. The largest difference between the various name brands and generic or compounded forms is the natural or synthetic composition. Both natural and synthetic vaginal estrogens will produce the desired result, but some women are sensitive to one composition or another. 


As long as you have completed the required new patient paperwork, we will have your allergies listed in order to avoid prescribing a form of the estrogen to which you are allergic. 


On the topic of health concerns when taking vaginal estrogen, we feel obliged to address a concern you may have heard or read about regarding vaginal estrogen: the risk of breast cancer. 


To put it simply, that concern was raised over the pill form of this product. The difference lies in how the two are absorbed into the body. When you receive your vaginal cream inserts, the paperwork included will address the side effects of oral estrogen in greater detail. Regardless, patients with a personal history of breast cancer will need an authorization by their oncologist in order for us to prescribe even the cream-form vaginal estrogen.

You may experience breast tenderness during the first two weeks of nightly application, but that should subside. If not, please call our office to notify us. 


Please know that we would not prescribe this product to you if we had any reason to believe you would be at risk of breast cancer or anything of the sort. 


Now for the bad news. If you don’t like using the vaginal estrogen and would prefer an alternative: unfortunately, we don’t know of any alternatives to good old-fashioned vaginal estrogen. Lubricants may help in the short-term, but they only last as long as you have recently applied them. Bio-identical hormones may provide some relief to symptoms of low estrogen, but you will need to consult a gynecologist who prescribed bio-identical hormones for more information. 


So let’s say that now you’re convinced — you’re sure you need vaginal estrogen. But how do you get it? Well, if the doctor prescribed it, your prescription should be waiting at the pharmacy. If your pharmacy does not facilitate electronic prescribing, he may give you a physical prescription to take to them or to shop for the best price.


Admittedly, vaginal estrogen can be expensive, based on your insurance. But we are happy to work with you to determine whether another name brand or a generic alternative would be more cost efficient. Alternatively, we have a relationship with a compounding pharmacy that might lower the cost.


If you are prescribed Premarin, but the pharmacy has filled the prescription with Estrace — fear not! Substituting any of the various types of vaginal estrogen is OK. Barring any allergic concerns, using one or the other will not affect the utility of the product. In fact, we provide samples of certain brands of vaginal estrogen, but your prescription may arrive as a different label. That, too, is OK.   



Last, but certainly not least, your question may involve a prescription from another doctor. What do you do if you’ve been prescribed vaginal estrogen previously or have another doctor managing it? Well if you are actively using vaginal estrogen when you come into our office, the doctor will discuss with you the management options. 


In other words, he will discuss how often you are inserting the estrogen and whether it would be wise to write you a new script to allow us to manage your vaginal estrogen use while you are under our care. But of course, this will be a discussion, so your input is very important, and we want you to feel comfortable moving forward with the plan of care.


So there you have it. We hope to have answered your biggest questions, but please do not hesitate to call the office with any other questions or concerns about this topic or others.


Until next time, be well and stay healthy!

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