Vaginal Oestrogen (Cream, Pessary or Ring)

Vaginal oestrogen treats the symptoms of genitourinary syndrome of menopause (GSM), which affects up to 80% of postmenopausal women:

• Vaginal dryness, soreness and itching

• Pain during sex (dyspareunia)

• Recurrent urinary tract infections (UTIs)

• Urinary urgency, frequency and stress incontinence

• Vaginal thinning and loss of elasticity

Symptoms are caused by falling oestrogen levels after menopause. Unlike hot flushes, vaginal symptoms tend to get worse over time without treatment - they rarely improve on their own.

Low-dose oestrogen applied directly to the vaginal tissues reverses the atrophy caused by oestrogen deficiency. It restores the vaginal lining (epithelium), increases natural moisture and lubrication, improves local blood flow, and normalises vaginal pH - reducing the risk of infections and UTIs.

The oestrogen stays local. Blood levels of estradiol remain within the normal postmenopausal range, meaning vaginal oestrogen does not carry the systemic risks of HRT tablets or patches. This is why it can be used long-term and often alongside systemic HRT for women whose vaginal symptoms don't fully resolve with systemic treatment alone.

Any woman with vaginal/urogenital menopausal symptoms. Can be used alongside systemic HRT or alone. Safe for long-term use. Can usually be used by women with a history of breast cancer (with oncologist guidance). Does NOT require progesterone alongside.

Ovestin Cream (estriol)

A topical cream applied with an applicator. Used nightly for 2-3 weeks, then reduced to twice weekly for maintenance. Good for women who want precise dose control. Estriol is a weaker oestrogen, which some women prefer.

Vagifem Pessaries (estradiol)

A small tablet inserted vaginally with a single-use applicator. One daily for 2 weeks, then one twice weekly. Mess-free, and preferred by women who find creams inconvenient.

Estring Vaginal Ring (estradiol)

A soft, flexible ring inserted into the vagina that releases a steady low dose of estradiol over 3 months. Insert it and forget about it, with no daily or weekly routine needed. Ideal for women who want a fit-and-forget option.

All three work locally with minimal systemic absorption. They do not carry the cardiovascular or breast cancer risks associated with systemic HRT. Most women can use vaginal oestrogen safely long-term, including many with a history of breast cancer (with specialist guidance).

Tracked: Tracked delivery, arrives in two working days - Free

When it arrives: Every order is sent tracked. Where this page says in post today, it goes out today. Where it says in post tomorrow, it goes out the next working day. On the rare occasions a medicine is unavailable, we will contact you to talk about timing and alternatives.

We dispense clinically equivalent generic medications where available. Prices shown are for the generic version. If you prefer the branded version, let us know in your order form and we will confirm any price difference.

Vaginal oestrogen from £20.99 per pack

Common: breast tenderness, headache, nausea, fluid retention, mood changes, irregular bleeding (usually settles within 3-6 months). Uncommon: bloating, leg cramps. Rare: venous thromboembolism (DVT/PE), stroke. Transdermal preparations carry lower VTE risk than oral.

Known or suspected breast cancer, undiagnosed vaginal bleeding, active or recent VTE, untreated endometrial hyperplasia, active liver disease, porphyria.

CYP3A4 inducers (carbamazepine, phenytoin, rifampicin, St John's Wort) reduce effectiveness. Thyroid replacement: may need dose adjustment.

Not for use in pregnancy or breastfeeding. Vaginal oestrogen (very low systemic absorption): may be used during breastfeeding under medical advice.

None required for vaginal oestrogen (minimal systemic absorption). Annual review recommended to assess ongoing need.

Use nightly for 2 weeks (loading phase), then twice weekly for maintenance. Can be used indefinitely - symptoms return if you stop. Minimal systemic absorption means no increased risk of blood clots or breast cancer. Does not need to be accompanied by progesterone. Can be used alongside systemic HRT for additional local benefit.