Estriol 0.01% cream

[Bluesheep8]

Hi everyone. Just a quick question...I've been prescribed this and I'm certain the GP said that it can be applied externally but it has an applicator and the instructions say internally. I'm not comfortable doing that at the moment so does anyone know if I can apply externally? Tia

Have been prescribed estriol but so worried about side effect not used it yet

Have been prescribed estriol but so worried about side effects have not used it yet

There are two strengths of Estriol cream, 0.01% which comes in an 80g tube and the applicator holds 5g so the tube is about 16 doses.

Ovestin is 10x stronger (0.1%) but the applicator holds 10x less, just 0.5g if cream per dose. The 15g tube is about 30 doses. It's less cream so less messy / not as much to slide out!

The amount of Estriol in a dose (measured using the applicator) is the same. Either can be used internally/ externally and absorbtion is negligible.

Ovestin (0.1%) is also significantly cheaper (costs the NHS less or you less if you buy your HRT rather than getting it through your GP) and lasts longer as there are more doses in a tube.

Production and transport costs are less as it's more concentrated so potentially also more environmentally friendly for that reason.

Using it at night means gravity helps keep it in place whilst you are asleep, this tends to be more if an issue if you're using 5g of the 0.01% cream internally via the applicator.

@Dogkeeper as someone else said up thread, the dose in the cream is low compared to oral HRT / patches etc so side effects to vaginal oestrogens are really unusual. It can make a big difference to how comfortable you feel down there though so I'd encourage you to give it a try if you've been prescribed it.

There is a certain amount of 'use or lose it' where vaginal atrophy is concerned so the sooner you start treatment the easier it is to slow/ prevent thinning and dryness

This is long and boring but might help somebody.

I suffered constant UTI symptoms and dryness during sex. This went on for months and was debilitating. I tried several estrogen creams. I have Ovestin the only one that got rid of the UTI symptoms. I only use quarter dose every other day and I only put it on the urethra area. I felt better pretty much straight away. When I use more than half a dose I get systemic symptoms (rapid heart rate, hot flushes, sore breasts) but I get no side effects from quarter to half dose. Because it is such a 'tiny smear' there isn't enough to go inside so I just use Yes water based lube during sex (the oil based lube gives me thrush).

I tried Blissel (low dose estrogen gel) to see if I could spread it inside as it's a lower dose so can have a lot more with no systemic effects. BUT the UTI symptoms were back within a fortnight. I switched back to my 'smear' of ovestin on the urethra and I felt good again.

So I know Ovestin works and my gynaecologist and GP said I can keep going with it every other day forever.

However I've recently also received estriol cream (0.01%) which is like a weaker version of Ovestin. I want to try using the equivalent amount but spread inside a little too. My GP is finally being great (after months of being useless with repeated thrush and cystitis medications). She now just puts 'vaginal estrogen cream' on my prescription and I ask for what I want from the pharmacist. Currently I am still experimenting so have three different creams in the cupboard. But at least I know Ovestin works! This was a turning point for me (and my GP).

I am just trying to strike the perfect balance between solution and side effects. Getting there!

I never got any stinging. Ovestin has only ever made me feel better down below. Hope my journey helps somebody.

Finally the best thing I did was see a sexual health doctor (referred by GP on nhs to rule out STIs). I had a thorough checkup, blood tests, swabs, urine tests. All normal. She said she was sure I had vaginal atrophy and wrote a letter of support to my GP and gynaecologist to encourage them to give me the vaginal ESTRIOL creams e.g. ovestin, estriol cream, blissel, imvaggiss. So I've been experimenting ever since. (I found estradiol gave me nausea and the SH consultant explained that estriol gives fewer side effects than estradiol. Super useful!

The blood tests also showed that my estrogen level was non existent (despite having periods every 60 days). So periods aren't a good indicator of need.

Finally finally, I keep using ovestin during periods when bleeding. I pop it on each morning after a shower every other day even when bleeding heavily!

Just in case this helps someone, I started using Estriol for painful sex 3 weeks ago.

Like the OP, I used it externally for the first 2 weeks as I was worried it would hurt to put the applicator inside me. I used in the mornings.

The only side effect I got was a slight headache which would last most of the day (although I also got a headache at night once which stopped me sleeping) so I am pleased I did not apply it at night.

I started using the applicator at the start of week 3 and am now on my 4th week so will stop the daily application this week and go to twice weekly.

Hopefully, sex will be less painful. I will update.

How did you get on? Just started to use it myself.

I've been using Ovestin as per the directions with applicator for 17 days now. I think I feel more sore now than when I started. I've read such conflicting information today, as to whether this is something that settles down: or could be a sign of infection and I should discontinue.. Did anyone experience a bad couple of weeks until your body adjusted to it?
Feel really disappointed and worried, I've been pushed from pillar to post by GPs. Common story, I know!
I do have a specialist appointment but it's some time off so I was really hoping to at least prevent the pain and dryness becoming any worse until I can get expert advice. I'm on 3 pumps Estrogel too, which is helping some, but not all, of the other dread symptoms.
I just need to know whether to persevere with the Ovestin.

If you’ve started the oestrogel around the same time as the Ovestin it may be that the extra oestrogen (mainly the gel) has triggered thrush. This is what happened to me. You may not have the typical white discharge that occurs with thrush as if you’ve got vaginal dryness it won’t have the moisture to create the discharge. I would try a thrush treatment and see if it helps make you less sore.

@Bagelsandbrie thankyou so much for that. I've been on the estrogel for quite a while. Added the Ovestin because I had four horrendous UTIs in a very short space of time. It was only after I went away and did my own reading that I approached the GP about a topical treatment.
He'd never mentioned that this could be quite common in menopause.
Now I've read your post, I realise it does feel similar to thrush. I'll see a pharmacist tomorrow. Never ending, isn't it. Thanks again.

It's really common to experience some discomfort at first @Notcopingbutstillstanding
But it does usually go away.

You say you've used it for 17 days- is that once a day for 14 days, then you've reduced it to twice a week?

Bear in mind all of that is guidance. Most women do need 14 days to make changes, but after that you may need it only once a week- everyone is different.

If you think you have thrush you can buy a test OTC now, and you can take an oral tablet bought OTC to clear it up.

There are many other types of vaginal estrogen, some even weaker than Ovestin, so if you're not getting on with it you could swap.

I'd suggest you drop down to applying once a week until the soreness gets better.

@JinglingHellsBells thankyou for that. You've confirmed a trip to the pharmacy is the best idea. I often find them more knowledgeable than the bloody GP anyway. It feels like putting out spot fires all the time. First patches in increasing doses, now estrogel which has been better in some ways, but still all kinds of symptoms. Hence the Ovestin.
I've had so much blamed on my mental health and fibromyalgia. But the more of my own research I do, I'm becoming convinced that menopause has much to do with my issues.
I had a surgical menopause at 45, six years ago and have never been "right" since. Last time I had a full night's sleep was July 2022.
Now I've gone on a whinge! Roll on the specialist appointment. Thankyou for your advice.

How are you getting on?

Ive not been consistent, but yes Ive been abit sore. I didnt get sore with vagifem pessaries. I may go back to them. Xx

@Glitterbells9 i used a canisten one off treatment which helped, so @Bagelsandbrie was onto something, I think.
Then started applying internally, with the remainder externally, with a finger instead of applicator. I think applying it evenly like this has has a better effect.
I'm using a maintenance dose now, after the recommended daily for 3 weeks.
So far, so good.
After reading another (highly depressing, but very validating) thread, I've also upped my estrogel from 3 pumps to 4 (the maximum).
Specialist appointment is six months away and GP has about as much menopause knowledge as the postman, so sod it. I can't go on being miserable. Many other symptoms are coming back/newly appearing.
So you'd recommend the pessaries if necessary?

Yes, I was also doing the utrogestan as a pessary so I wanted the cream I could apply externally when utogestan was inside as I struggle that week before my period the most.

Ive gone on the coil now for progesterone so I guess the pessaries will be easier to manage again.

I really wanted to use it externally too, but I do seem sore from it. My chemist always gives out the generic ones unless stated on prescription for the branded ones, so they’ve probably given me the cheapest crap version cream of whats available.

xx

@Glitterbells9 Just to reassure you, there is no difference at all with generic and branded.
Ovestin 'lost' its patent last year so all vaginal estrogen of 0.01% is generic. There is a new 'brand' called Ovesse but it's more expensive bought over the counter with no prescription.
I get mine on a private prescription and pay the retail price, which is about £8 a tube.

Thank you, thats good to know. Maybe I am a little sensitive since Ive stopped estrogel but the vaginal cream feels like its burning. Xx

@glitterbells I'm using it externally but only about 2 to 3x a week. I'm tolerating it well now.
I do think that dose of Canestan helped as suggested by @Bagelsandbrie
I feel much better down there, definitely, but of course I've probably muddled the issue by upping my estrogel, because things are better internally again.
I'm sure everyone here can relate: you become so desperate, you'll try anything.
So I'm throwing everything at my symptoms till I have proper bloods and a consultation with someone who knows their arse from their elbow.
I've noticed since upping the estrogel, that other dryness has improved. Sore eyes, needing frequent eye drops, skin that needs moisturising three times a day, just for it to be comfortable.
I didn't even connect those as meno symptoms till I read another thread on here!