Vaginal oestrogen

• Adverse events associated with vaginal oestrogen include discharge, skin irritation, odour and a greater frequency of mycotic infections.
• Other side effects might include vaginal bleeding, breast pain and nausea.

STRATEGIES TO REDUCE VAGINAL SIDE EFFECTS INCLUDE:

1. GIVING THINGS TIME

• Side effects are more likely to happen at treatment initiation when the vaginal epithelium is at its thinnest and absorption into the systemic circulation is higher.
• Side effects usually lessen with time as the vaginal epithelium thickens and absorption becomes minimal.

2. REDUCE DOSE

• If side effects persist a reduced dose can be considered.
• Estriol preparations are available in ultralow doses. An example is Imvaggis.

3. CHANGE PREPARATION

• Different adverse event profiles might reflect variations in product dose and formulation.
• Changing preparation may improve side effect profiles.
• In general, the Estring ring has a high user acceptability rate with minimal discharge or skin irritation.
• A user may get on better with estriol compared to estradiol and vice versa.

4. CONSIDER NON-HORMONAL ALTERNATIVES

• Vaginal lubricants or moisturisers.