Estrogens (Vaginal)

Proper Use of This Medicine

Vaginal estrogen products usually come with patient directions. Read them carefully before using this medicine .

Wash your hands before and after using the medicine. Also, keep the medicine out of your eyes. If this medicine does get into your eyes, wash them out immediately, but carefully, with large amounts of tap water. If your eyes still burn or are painful, check with your doctor.

Use this medicine only as directed. Do not use more of it and do not use it for a longer time than your doctor ordered . It can take up to 4 months to see the full effect of the estrogens. Your doctor may reconsider continuing your estrogen treatment or may lower your dose several times within the first one or two months, and every 3 to 6 months after that. Sometimes a switch to oral estrogens may be required for added benefits or for higher doses. When using the estradiol vaginal insert, you will need to replace it every 3 months or remove it after 3 months.

For vaginal creams or suppositories - Vaginal creams and some vaginal suppositories are inserted with a plastic applicator. Directions for using the applicator are supplied with your medicine. If you do not see your dose marked on the applicator, ask your health care professional for more information.

• To fill the applicator for cream dosage forms :
  • Break the metal seal at the opening of the tube by using the point on the top of the cap.
  • Screw the applicator onto the tube.
  • Squeeze the medicine into the applicator slowly until it is measured properly.
  • Remove the applicator from the tube. Replace the cap on the tube.
• To fill the applicator for suppository dosage form
  • Place the suppository into the applicator.
• To place the dose using the applicator for cream and suppository dosage forms :
  • Relax while lying on your back with your knees bent or stand with one foot on a chair.
  • Hold the full applicator in one hand. Slide the applicator slowly into the vagina. Stop before it becomes uncomfortable.
  • Slowly press the plunger until it stops.
  • Withdraw the applicator. The medicine will be left behind in the vagina.
• To care for the applicator for cream and suppository dosage forms :
  • Clean the applicator after use by pulling the plunger out of the applicator and washing both parts completely in warm, soapy water. Do not use hot or boiling water .
  • Rinse well.
  • After drying the applicator, replace the plunger.

For vaginal insert dosage form

• To place the vaginal insert
  • Relax while lying on your back with your knees bent or stand with one foot on a chair.
  • Pinch or press the sides of the vaginal insert together, between your forefinger and middle finger.
  • With one hand, part the folds of skin around your vagina.
  • Slide the vaginal insert slowly into the upper third of your vagina. Stop before it becomes uncomfortable. The exact location is not too important but it should be comfortable.
  • If it seems uncomfortable, then carefully push the vaginal insert higher into the vagina.
• To remove the vaginal insert
  • Stand with one foot on a chair.
  • Slide one finger into the vagina and hook it around the closest part of the vaginal insert.
  • Slowly pull the vaginal insert out.
  • Dispose of the vaginal insert by wrapping it up and throwing it into the trash. Do not flush it down the toilet .

Dosing - The dose of vaginal estrogens will be different for different women. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

For conjugated estrogens
• For vaginal dosage form (cream):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis):
    • Adults: 0.3 to 1.25 milligrams (mg) of conjugated estrogens (one half to two grams of cream) inserted into the vagina once a day or as directed by your doctor to achieve the lowest dose possible. Usually your doctor will want you to use this medicine for only three weeks of each month (three weeks on and one week off).

For dienestrol
• For vaginal dosage form (cream):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis):
    • Adults: At first, one applicatorful of 0.01% cream inserted into the vagina one or two times a day for one to two weeks, decreasing the dose by one half over two and four weeks. After four weeks, your doctor will probably ask you to use the medicine less often, such as one applicatorful one to three times a week and for only three weeks of each month (three weeks on and one week off).

For estradiol
• For vaginal dosage form (cream):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis):
    • Adults: 200 to 400 micrograms (mcg) of estradiol (two to four grams of cream) inserted into the vagina once a day for one to two weeks, decreasing the dose by one half over two and four weeks. After four weeks, your doctor will probably ask you to use the medicine less often, such as 100 mcg (one gram of cream) one to three times a week and for only three weeks of each month (three weeks on and one week off).
• For vaginal dosage form (insert):
  • For treating a genital skin condition (vulvar atrophy), inflammation of the vagina (atrophic vaginitis) in postmenopausal women, and inflammation of the urethra (urethritis) in postmenopausal women:
    • Adults: 2 milligrams (mg) of estradiol (7.5 mcg released every twenty-four hours with continuous use) and replaced every three months.

For estrone
• For vaginal dosage form (cream):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis) in postmenopausal women:
    • Adults: 2 to 4 milligrams (mg) of estrone (two to four grams of cream) inserted into the vagina once a day or as directed by your doctor.
• For vaginal dosage form (suppository):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis) in postmenopausal women:
    • Adults: 250 to 500 micrograms (mcg) inserted into the vagina once a day or as directed by your doctor.

For estropipate
• For vaginal dosage form (cream):
  • For treating a genital skin condition (vulvar atrophy) and inflammation of the vagina (atrophic vaginitis):
    • Adults: 3 to 6 milligrams (mg) of estropipate (two to four grams of cream) inserted into the vagina once a day. Your doctor will probably ask you to use the medicine for only three weeks of each month (three weeks on and one week off).

Missed dose - When using the suppository or cream several times a week: If you miss a dose of this medicine and remember it within 1 or 2 days of the missed dose, use the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

When using the cream or suppositories more than several times a week: If you miss a dose of this medicine, use it as soon as possible if remembered within 12 hours of the missed dose. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Keep the medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.