Urological and Gynaecological Chronic Pelvic Pain by Robert M. Moldwin

Author:Robert M. Moldwin
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

A. Estradiol (Estrace®) and Conjugated Estrogen (Premarin®) Creams

Estrace and premarin creams are the most common choice of vaginal product for the treatment of atrophic vaginitis. Estrace contains 0.01 % estradiol and is indicated for the localized treatment of vulval and vaginal atrophy. General dosage is 2–4 g daily for 1–2 weeks followed by a gradual taper to a maintenance dose of 1 g one to three times per week after restoration of the vaginal mucosa has been achieved. Studies have shown that even at low 10 μg dose, all patients responded symptomatically to treatment with estrace, with vaginal cytology and pH showing improvement and serum estradiol levels remaining in the postmenopausal range [9].

Premarin is a conjugated equine estrogen (CEE) cream (0.625 mg CEE/g) indicated for treatment of general symptoms of atrophic vaginitis in addition to the specific treatment of moderate to severe dyspareunia. General dosage is 0.5–2 g in a cyclic regimen, daily for 21 days then off for 7 days. It has been shown to be as effective as both the estradiol ring and tablet in decreasing symptoms of vulvovaginal atrophy [7]. Increased levels of serum estradiol have been reported with use of CEE when compared to other local estrogen therapy [3]. Adverse events such as endometrial proliferation, uterine bleeding, perineal pain, and breast pain and tenderness have been reported more often with the use of the CEE cream than with other therapy; however, these events have been relatively mild [2].

Creams may have an advantage over tablets or rings for some patients as they are soothing, can be directly applied to the vulval and vaginal area, and also providing flexibility in dosing and frequency of administration as required by the individual patient. They are also low in cost. On the other hand, compliance rates are often low among these patients as many see the creams as messy, causing leakage and irritation, and also inconvenient, as the user must measure amount of cream used by themselves [6].

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