From the Guidelines
The cheapest topical vaginal estrogen option is typically generic estriol vaginal cream, which is a more cost-effective alternative to estradiol-based products. When considering the treatment of atrophic vaginitis, particularly in patients with a history of breast cancer, the choice of vaginal estrogen is crucial 1. Vaginal estrogens are effective in relieving symptomatic atrophic vaginitis, and there is evidence that they may be superior to systemic treatment for vaginal dryness 1.
Key Considerations
- Generic estriol vaginal cream is as effective as estradiol-based products in treating symptomatic women 1.
- Estriol is a less potent estrogen than estradiol and cannot be converted to estradiol, making it a preferable option for patients with a history of breast cancer, particularly those using aromatase inhibitors 1.
- The cost of generic estriol vaginal cream is significantly lower than brand-name products, such as Premarin or Estrace cream, and vaginal tablets (Vagifem) or rings (Estring).
Administration and Side Effects
To use generic estriol vaginal cream, insert the cream into the vagina using the provided applicator, preferably at bedtime to minimize leakage. Initially, you might start with daily application for 1-2 weeks before reducing to the maintenance schedule. Side effects are usually minimal but may include local irritation or discharge.
Cost and Availability
The cost of generic estriol vaginal cream can vary depending on the location and availability of patient assistance programs or prescription discount cards. However, it is generally more affordable than other topical vaginal estrogen options, making it a viable choice for patients with severe cost concerns.
From the Research
Cost Comparison of Topical Vaginal Estrogen
- The average cost of compounded estrogen was $42.22, as reported in a study published in 2014 2.
- In comparison, the average cost for branded vaginal estrogen preparation was $137.70 at the University of Oklahoma Outpatient Pharmacy, and $82.42 nationally 2.
- The use of compounded estrogen resulted in cost savings of $94.98 (69%) locally and $40.20 (51%) nationally 2.
Efficacy and Safety of Vaginal Estrogen Products
- A systematic review published in 2019 found that vaginal estrogen products are effective in treating genitourinary syndrome of menopause, with doses as low as 4 μg 3.
- The review also found that vaginal estrogen products are safe, with few adverse effects, although long-term controlled clinical trial safety data are limited 3.
- Another systematic review published in 2020 found that newer low-dose estradiol rings, tablets, and inserts appear to induce the least increases in serum hormones, possibly indicating greater safety 4.
Serum Estrogen Levels with Vaginal Estrogen Preparations
- A study published in 2009 found that serum estradiol levels increased by an average of 5.4-fold after daily administration of 25 μg estradiol or 1 g (0.625 mg) conjugated estrogens cream 5.
- The study also found that serum estrone levels increased by 150% with Vagifem and 500% with Premarin cream 5.
- A comparative study published in 2001 found that conjugated estrogen cream showed superior efficacy in alleviating vaginal dryness and dyspareunia compared to estradiol vaginal tablet 6.