Vaginal oestrogen and DHEA

Updated on 08 Dec 2023
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VAGINAL RING

Name	Form	Hormone	Dose	Administration	Regime	Notes	Vegan suitable
Estring	Ring	Estradiol hemihydrate 2.0mg ring	7.5mcg/24 hours	Self inserted. It can be inserted by a health care professional if preferred	One ring used for 90 days. Inserted into upper third of vagina and used continuously	1. Equivalent to using 5x estradiol 10mcg pessaries a week 2. It can be placed above a ring pessary 3. Very useful in women who cannot manage daily use, have busy schedules or cognitive decline	Yes

Name

Form

Hormone

Dose

Administration

Regime

Notes

Vegan suitable

Estring

Ring

Estradiol hemihydrate 2.0mg ring

7.5mcg/24 hours

Self inserted. It can be inserted by a health care professional if preferred

One ring used for 90 days. Inserted into upper third of vagina and used continuously

1. Equivalent to using 5x estradiol 10mcg pessaries a week

2. It can be placed above a ring pessary

3. Very useful in women who cannot manage daily use, have busy schedules or cognitive decline

Yes

VAGINAL PESSARIES

Name	Form	Hormone	Dose	Administration	Regime	Notes	Vegan suitability
Vagifem	Pessary	Estradiol hemihydrate	10mcg/ pessary	Single use applicator	Daily for 2 weeks and then twice-weekly	1. Some women may need more frequent dosage, and data exists showing that 50mcg per week does not need progestogen opposition. 2. No data available above this level	No
Vagirux	Pessary	Estradiol hemihydrate	10mcg/ pessary	Reusable applicator	Daily for 2 weeks and then twice-weekly	1. Equivalent to vagifem other than the applicator can be reused making it more environmentally friendly	No
Imvaggis	Pessary	Estriol	30mcg per pessary	Self inserted using fingers	Daily for 3 weeks and then twice-weekly	1. Can damage latex condoms 2. Contains an ultralow dose of estriol	Yes

VAGINAL GEL

Name	Form	Hormone	Dose	Administration	Regime	Notes	Vegan suitable
Blissel	Gel	Estriol	50mcg per applicator	Reusable applicator	Daily for 3 weeks, then twice-weekly	1. Contains an ultralow dose estriol 2. Aqueous based formulation, which is less greasy than creams	Yes

VAGINAL CREAMS

Name	Form	Hormone	Dose	Administration	Regime	Notes	Vegan suitable
Estriol cream 0.1% (Ovestin)	Cream	Estriol	0.5mg per applicator	Applicator. It can be applied to external genitalia	Daily for 2 weeks, then twice-weekly	1. Can be applied with a finger 2. Can be used internally and externally Helpful for dryness at the introitus	Yes
Estriol cream 0.01% (Gynest)	Cream	Estriol	0.5mg per applicator	Applicator. It can be applied to external genitalia	Daily for 2 weeks then twice-weekly	1. Can damage latex condoms 2. Avoid in patients with allergies to peanuts 3. More expensive than the 0.1% brand 4. Volume of dosage, often seen as messy	Yes

VAGINAL DHEA PESSARY

Intrarosa

Pessary

Prasterone (DHEA)

6.5mg

Applicator

Once daily

1. Can damage latex condoms
2. This is DHEA which is converted by the vaginal epithelium first to testosterone and then potentially to oestrogen.
3. Availability will depend on local formulary

Yes

References and Further Information:

Primary Care Women's Health Forum (PCWHF). Vulvovaginal atrophy (VVA) treatment comparison table.

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