Why would you use vaginal estrogen?
The best thing to prevent vaginal atrophy is vaginal estrogen placement. There are three ways to give local estrogen to the estrogen receptors in and around your vagina and bladder. A vaginal estrogen cream, a vaginal estrogen pill, or a vaginal estrogen ring are the three options. The first option is the vaginal cream. There are two FDA-approved vaginal creams to help build up the vaginal skin (mucosa). They are Estrace® Vaginal Cream, and Premarin® Vaginal Cream. The Estrace® Vaginal Cream is estradiol cream. It contains one estrogen: estradiol. Premarin® Vaginal Cream is what is called a conjugated estrogen cream. This means that there are several estrogens conjugated (or combined) together: estradiol, estriol, and estrone. The cream is formulated to adhere to the walls of the vagina and not leak out, but women find that any leakage is annoying.
The second option is a small vaginal pill that contains estradiol only. It is called Vagifem® and only comes in one dose in the United States. There is only one company that makes this product. The pill comes in the top of a light blue applicator that is put into the vagina. The pill is released on the other end by “clicking” the pill into the vagina (like clicking a ball-point pen). This is by far the easiest and, in my opinion, the most frequent choice that patients choose. It is not messy (like the cream can be) and does not “leak out” of the vagina when you stand up.
The third option for vaginal (local) estrogen is the Estring® vaginal ring. The Estring® is approved for vaginal dryness. This is a very convenient way to give local estrogen if you don’t mind sticking your fingers in your vagina to put it in or take it out. It is very easy to use. Once the package is opened, the estrogen is delivered right to the vagina from the ring; the medication lasts for three months. At the end of three months, you take it out and put in another. You can take it out every day if you want to wash it off and you can take it out for intercourse. It is a silastic ring impregnated with estradiol. You take it out of the package, squeeze it, and push it in your vagina as high as you can. For those of you who used a diaphragm many years ago, you put it in your vagina exactly the same way.