Estriol Cream Dosing
For vaginal atrophy, estriol cream 0.5 mg should be applied intravaginally once daily for 2 weeks, followed by a maintenance dose of twice weekly thereafter. 1
Initial Treatment Phase
- Apply 0.5 mg estriol cream intravaginally once daily for 14 days to restore vaginal epithelium and normalize pH 1, 2
- This loading phase is critical for achieving adequate tissue restoration before transitioning to maintenance therapy 2
Maintenance Phase
- After the initial 2-week period, reduce to 0.5 mg applied twice weekly (e.g., Monday and Thursday evenings) 1
- This maintenance regimen has been shown to significantly reduce recurrent UTI rates (0.5 episodes/patient-year vs 5.9 with placebo, p<0.001) 1
- Continue maintenance therapy indefinitely, as vaginal atrophy symptoms persist without ongoing treatment, unlike vasomotor symptoms which may resolve over time 3, 4
Clinical Context and Advantages
- Estriol is a weaker estrogen than estradiol and cannot be converted to estradiol in the steroid pathway, making it potentially safer in hormone-sensitive populations 3, 4
- For women on aromatase inhibitors or with breast cancer history, estriol-containing preparations are preferable over estradiol formulations 1, 3
- In the recurrent UTI prevention trial, 61% of women treated with estriol cream had lactobacilli restored on vaginal culture versus 0% with placebo 1
Important Caveats
- Do not discontinue treatment prematurely - symptoms will recur as vaginal atrophy persists indefinitely without continued estrogen therapy 3, 4
- Some women may experience transient "vaginal heat" sensation during the first few days of treatment, but this typically resolves without intervention 2
- For women without a uterus, estrogen-only formulations like estriol are appropriate and do not require progestogen addition 3, 5
- Reassess treatment necessity at 3-6 month intervals, though most postmenopausal women will require ongoing therapy 5