Vaginal estrogens
Vaginal estrogen
What is Ovestin (vaginal estrogen cream)?
Ovestin is an estrogen cream. Unlike systemic MHT (patches, gels, or pills), it acts locally around the vagina and vulva. The estrogen it contains is estriol, a weak body-identical - meaning itâs the same as the estrogen naturally produced in the body.
You can also get Vagifem, this isn't funded in NZ, but it contains estradiol.
Why might we need it?
Vaginal estrogen creams help protect the vaginal and vulval skin, reduce inflammation, and prevent thinning or atrophy.
Around 80% of women are affected by genitourinary syndrome of menopause (GSM).
Symptoms can include:
- Itching or dryness
- Skin inflammation (dermatitis)
- Pain during sex
- Recurrent vaginal or urinary infections
- Changes in discharge or smell
- Problems passing urine
- Urinary urgency
These symptoms often worsen over time, so starting treatment early is beneficial. Vaginal symptoms are very common after menopause, but they can also appear earlier and are often under-recognised.
Possible risks with using Ovestin cream
The estrogen in Ovestin cream works only locally, so it does not carry the same risks as systemic MHT. Thereâs no known increased risk of breast or uterine cancer.
Possible side effects of Ovestin
Most women tolerate Ovestin well. Because the estrogen works locally, side effects are usually mild and temporary. Common ones include:
- Mild vaginal irritation or itching when first starting
- Stinging or burning after application (often improves within a couple of weeks)
- Increased vaginal discharge
- Breast tenderness (rare, usually if also on systemic estrogen)
Serious side effects are very rare, but if you notice persistent pain, unusual bleeding, or any concerning symptoms, see your doctor.
â° Starting Ovestin cream
- Begin with daily use for 2â3 weeks.
- Then reduce to twice a week for maintenance.
- Some women need more frequent use from time to time.
- About 50% of women already using systemic MHT donât need extra vaginal estrogen.
- Symptoms may improve once estrogen patches reach therapeutic levels.
- Mild stinging at first is common and usually settles within a couple of weeks.
âUsing the applicator or your finger
Some women find the applicator can be uncomfortable or tricky to clean. An alternative is to measure a dose onto your finger and apply it internally or externally where needed.
- Cream works best when applied high in the vagina (front wall).
- Once youâre confident with the dose amount, you can use your finger instead of the applicator.
FAQs about using Ovestin
đŹ What if I have my period when using Ovestin?
You can skip doses during your period, or just apply it externally if more comfortable.
đŹ Can I have sex after using it?
Itâs not ideal to have sex immediately after applying Ovestin, wait a few hours if possible.
đŹ What if I do have sex after applying it?
Absorption through penile skin is minimal, so thereâs no need to worry, but best not to make it a regular habit.
đŹ Can I use it on my face or elsewhere?
Not recommended. Ovestin contains chlorhexidine, a preservative better suited to internal application. Ovestin is only indicated for use around the vulva and vagina.
đŹ What if I feel embarrassed asking for it?
Youâre not alone, these symptoms are common and very real. You can write a note, ask a pharmacist, or bring a prepared question to your doctor.
đŹ Will I need it forever?
Possibly. Symptoms often return when treatment stops. Think of it like a skin cream - ongoing dryness may need ongoing support.
đŹ Can Ovestin cause thrush?
Sometimes. But donât assume - it could be irritation or another cause. Always get it checked by your doctor before treating yourself.
đŹ Iâm on the pill but still have vaginal dryness - is that possible?
Yes. Some combined oral contraceptives can lower local estrogen and even shrink the labia minora mildly, causing dryness or discomfort.
đŹ What else can I use?
- Moisturisers for long-term hydration
- Lubricants for comfort during sex or intimacy
đŹ Will I still need lubricant if Iâm using Ovestin?
Maybe. Using a lubricant doesnât mean Ovestin isnât working. Itâs simply an extra tool many people still find helpful.
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