What is ovestin/vaginal estrogen cream?

Ovestin is an estrogen (hormonal) cream. It is different to the systemic MHT estrogen (patches/gels/pills) in that it only acts locally around the vagina. The estrogen it contains is bio-identical i.e. the same as the one that is produced naturally in our bodies.

Why might we need it?

Estrogen deficiency can be seen in the vulval/vaginal tissues. Vaginal estrogen creams protect the vaginal and vulval skin, decrease inflammation, and atrophy/thinning/wasting. The symptoms of vaginal symptoms or genitourinary syndrome of menopause (GSM) can include itching, dryness, dermatitis (skin inflammation) pain during intercourse, dragging/prolapse, vaginal and urinary infections, change in vaginal discharge or smell, problems with passing urine and also urinary incontinence. GSM affects 80% of women. Vaginal symptoms will get progressively worse over time so starting treatment as early as possible is beneficial. We can help to prevent and treat these symptoms by using this cream. These symptoms are much more common as women become menopausal, but they are also understated and not talked about earlier in life.

Risks

The estrogen from Ovestin cream only acts locally so doesn't come with the same risks as MHT/HRT. There's no known risk of breast or uterine cancer.

Starting Ovestin Cream

• When starting - use daily for 2-3 weeks and then 2x per week.  
• Maintenance cream dosing is twice a week, however every few weeks you may find you need to use it more than this. 
• 50% of women on systemic MHT do not need topical estrogen. You may not need it once we get up to therapeutic patch dosing
• If the cream stings initially when you use it, this is not uncommon. And the stinging should settle within a couple of weeks.  
• May not require ongoing

Using Ovestin Cream

The applicator can be uncomfortable to use and tricky to wash. An alternative method is to use it to measure an initial dose onto your finger then insert using your finger and apply it where suits you e.g. internally or externally. Maximal absorption is when the cream is inserted high into the vagina and absorbed through the front wall of the vagina. If you can remember the size of the dosage, next time you can measure it onto your finger, and just check in with the applicator if you're ever uncertain.

Common Questions About Using Ovestin

💬 What if I have my period when using Ovestin?
You can skip it during your period, or just apply it externally (around the vulva) if that feels more comfortable.

💬 Can I have sex after using it?
It’s not ideal to have sex immediately after applying Ovestin—wait a few hours if possible.

💬 What happens if I do have sex after applying it?
There’s very minimal absorption through penile skin, which is thick and not easily permeable—so no need to worry.

💬 Can I use it on my face or other areas?
Not recommended. Ovestin contains chlorhexidine, a preservative better suited to internal application. (Why women's products include it is a conversation for another day...)

💬 What if I’m too embarrassed to ask for it?
You’re not alone—and you absolutely deserve relief. You can request it in writing, ask a pharmacist, or bring a prepared question to your GP. Vulval and vaginal symptoms are real, treatable, and worthy of care.

💬 Will I need to use it forever?
Possibly. Symptoms often return when it's stopped, and long-term use is safe for most people. Think of it like a skin cream: ongoing dryness may need ongoing support.

💬 Can Ovestin give me thrush?
Yes, in some cases. But before assuming it's thrush, get it properly diagnosed—it could be irritation or another issue.

💬 I’m on the pill and still have vaginal dryness—is that possible?
Yes—very. Some combined oral contraceptive pills can cause up to 25% shrinkage of the labia minora, and reduce local estrogen levels, leading to dryness or discomfort.

💬 What else can I use?

• Moisturisers (for long-term hydration)
• Lubricants (for comfort with sex or intimacy)

💬 Will I still need lubricant if I’m using Ovestin?
Maybe! Using a lubricant doesn’t mean you’re failing—it’s a helpful tool, and many people still benefit from it even with vaginal estrogen.

We have a course on vaginal estrogen coming soon!