Vaginal estrogen

Vaginal estrogen is a form of estrogen that is delivered by intravaginal administration. Vaginally administered estrogens are thereby exerting their effects mainly in the nearby tissue, with more limited systemic effects compared to orally administered estrogens. It will not protect against osteoporosis. With perhaps the exception of the Femring, it also will not alleviate the hot flashes and hormonal imbalance caused by menopause.

Indications

Vaginally administered estrogen are usually used to treat some menopausal symptoms that are isolated to the vagina, vulva and urethra.

Atrophic vaginitis, with presentations such as dryness and soreness in the vagina and dyspareunia
Itching, redness, or soreness of the vulva
Urinary urgency, or dysuria

Forms

Vaginal tablets, including Vagifem which contains estradiol
Vaginal creams, including Premarin which is a compound cream consisting primarily of conjugated estrogens isolated from mare's urine. Another vaginal cream is Ovesterin, which contains estriol.
Vaginal rings, which are polymeric drug delivery devices designed to provide controlled release of drugs to the vagina over extended periods of time. Although the Femring might be able to ease hot flashes, this does not appear to be the case for other vaginal estrogen rings or vaginal creams.

Side effects

Most of the vaginally administered estrogens are synthetic and therefore cause the following side effects
Serious side effects:

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
sudden numbness or weakness, especially on one side of the body;
sudden severe headache, confusion, problems with vision, speech, or balance;
pain, swelling, warmth, or redness in one or both legs;
abnormal vaginal bleeding;
migraine headache;
pain, swelling, or tenderness in your stomach;
confusion, problems with memory or concentration;
jaundice ;
swelling in your hands, ankles, or feet; or
a breast lump.

Less serious side effects may include:

mild nausea, vomiting, bloating, stomach cramps;
breast pain, tenderness, or swelling;
freckles or darkening of facial skin;
increased hair growth, loss of scalp hair;
changes in weight or appetite;
problems with contact lenses;
vaginal itching or discharge;
changes in your menstrual periods, decreased sex drive; or
headache, nervousness, dizziness, tired feeling.

Contraindications

Estrogen administered vaginally should not be given to persons who are:

Pregnant women

Estrogen should not be used while pregnant as it could cause serious birth defects.

Breastfeeding

Estrogen passes into the breast milk and will cause a decrease in the production and quality of breast milk.

Alternatives

To effectively alleviate the symptoms of menopause, it is best to take oral estrogen instead of topical estrogen since the results are systemic and it will rejuvenate the entire reproductive system and not just the perineal area.
Phytoestrogens are plant derived compounds found in a wide variety of foods. Several health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms are frequently attributed to phytoestrogens but many are also considered to have the potential to cause adverse health effects. Plants such as Kacip Fatimah have been found to contain phytoestrogens that could alleviate some symptoms of menopause.