Common Vaginal Estrogen Creams for Topical Application
The most common vaginal estrogen creams for topical application are Premarin (conjugated estrogens) and Estrace (estradiol), which are effective treatments for vaginal dryness and atrophic vaginitis. 1
Available Vaginal Estrogen Formulations
Estrogen Creams
- Premarin Vaginal Cream (conjugated equine estrogens 0.625 mg/g)
- Estrace Vaginal Cream (estradiol 0.1 mg/g)
- Estradiol Vaginal Cream (0.003% - ultra-low dose option)
Other Vaginal Estrogen Formulations
- Vaginal tablets (e.g., Vagifem - estradiol 10 or 25 μg)
- Vaginal rings (e.g., Estring - estradiol-releasing)
- Vaginal inserts containing estriol
Efficacy Comparison
Both Premarin and Estrace vaginal creams are equally effective for treating:
- Vaginal dryness
- Vaginal soreness and irritation
- Dyspareunia (painful intercourse)
- Urinary tract infection prevention 1
However, patient acceptability tends to be higher with vaginal tablets compared to creams, with lower withdrawal rates (10% vs 32%) 2, 3.
Important Clinical Considerations
Systemic Absorption
- Vaginal creams can result in significant systemic absorption of estrogen 4
- Estradiol vaginal tablets (Vagifem) demonstrate more localized effects with less systemic absorption than creams 2
- For patients taking aromatase inhibitors, preparations containing estriol (such as Ovestin) may be preferable as they cannot be converted to estradiol 1
Special Populations
- Breast cancer survivors: Vaginal estrogen has been widely used to treat atrophic vaginitis in breast cancer survivors 1
- Recent evidence supports using vaginal estrogen therapy for breast cancer patients with genitourinary symptoms when nonhormonal treatments fail 1
- A large cohort study of almost 50,000 breast cancer patients showed no evidence of increased breast cancer-specific mortality with vaginal estrogen use 1
- However, caution is advised in patients on aromatase inhibitors 1
Alternative Options
For patients where estrogen is contraindicated or concerning:
- Non-hormonal vaginal moisturizers (e.g., Replens, Sylk)
- Vaginal DHEA (prasterone) 1
- Ospemifene (for non-hormone sensitive cancer survivors) 1
Application Guidelines
- Initial treatment: Daily application for 1-2 weeks
- Maintenance: 2-3 applications per week 5
- Apply using the provided applicator, typically at bedtime
Potential Side Effects
- Local irritation
- Vaginal discharge
- Vaginal bleeding (rare)
- Breast tenderness (with systemic absorption)
- Endometrial proliferation (more common with creams than tablets) 2
Vaginal estrogen creams remain one of the most effective treatments for vaginal dryness and atrophic vaginitis, with multiple formulation options available to meet individual patient needs and concerns.