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Topical Oestrogen Treatment for Vaginal, Vulval and Urinary Symptoms – Some Key Points to be Aware of:

I have written about the symptomatic benefits of topical, local oestrogen treatments. I wanted to point out some particular issues which are important or useful to be aware of. These treatments are effective, but only while they are being used. This means if you stop using them, your symptoms will return and start to deteriorate over time. This is less likely if you are also using systemic oestrogen replacement. It is worth being aware of this because the symptoms and anatomical changes that can occur in the vulva, vagina and urinary system with oestrogen depletion are easier to treat and have better outcomes from treatment if started early on. Early symptoms include changes in discharge, discomfort in the vulva which comes and goes and discomfort with sex. Symptoms can start in the peri menopause or later once a woman has entered their menopause.

Don’t give up with the first treatment you try. Sometimes topical treatments can cause some stinging or discomfort initially which is unpleasant and may put someone off continuing it. This can occur because the skin is fragile and thin. Some women benefit from several weeks of using a vaginal moisturiser alone before commencing local oestrogen, to minimise or avoid any discomfort when starting the treatment.

The first local oestrogen you use may not be as effective as you would hope, or you might be finding it tricky to use. If this happens, return to your health professional and ask about other choices. There are several types of local oestrogens that can be tried alone, or in combination. Symptom relieve from treatment may takes months.

If your symptoms are not improving with treatment, it would be advisable to see your GP for an examination. It might be an alternative diagnosis which needs a different treatment.

You can use local oestrogen with systemic HRT. It is not uncommon to need both for symptoms and it is safe. On starting local oestrogen treatment sometimes while the skin of the vulva and vagina is still thin, initially a small amount of oestrogen can absorb into the blood stream. Once the tissues have thickened up and are more robust with treatment, only a very tiny amount of local oestrogen absorbs into the bloods stream; which is why using both is safe. If you are using only local oestrogens on the vulva and vagina, because of the very low systemic absorption, women do not need to have additional progesterone to protect the lining of the womb.

The ‘information’ leaflet which are in the packets of local, topical oestrogen products list many possible, scary side effects and warnings. Such as risks of heart disease, cancer, stroke and clots. These leaflets are incorrect and inaccurate. They list these risks based on evidence which is not relevant to local, topical oestrogens. There is some behind the scenes work happening to try and get the information on these leaflets corrected so they are accurate. In the meantime, please ignore them. They cause unnecessary worry.

A standard dose of topical oestrogen, for one year is the equivalent of one tablet of oral HRT. Therefore typically, 1 year of local, topical oestrogen is 1/365 th of the standard strength of systemic HRT, in terms of absorption into the blood stream. This is why it is considered safe for the large majority of women. The studies overall indicate it is unlikely to significantly increase the risk of recurrent breast cancer if a woman has had a diagnosis in the past. There is one group of women when local oestrogen is not advised, and that is women with a diagnosis of breast cancer and taking an aromatase inhibitor. If you have had breast cancer and are experiencing vulval, vaginal or urinary symptoms due to low oestrogen, consider discussing with your doctor whether local, topical oestrogen is an option for you. It can lead to a significant improvement in quality of life.

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