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Relieving Dryness and Pain: Which Vaginal Estrogen is Best for You?

by Dr. Sharon Orrange on November 18, 2014 at 2:07 pm

Estring, Premarin cream or Vagifem: which is better? Without estrogen replacement, one third of women experience symptoms of atrophic vaginitis including dryness, irritation, itching and pain during sex. All vaginal estrogens have been shown to relieve these symptoms and improve quality of life for these women. In addition, vaginal estrogen therapy has been shown to have a favorable effect on libido/sex drive, urinary tract infections and incontinence. So if they all work, which one is best for you?

There are three main choices of estrogens used in the vagina. First know that creams, tablets and estradiol rings inserted in the vagina all appear to be equally effective for the symptoms of atrophic vaginitis. All of them also generally carry the same risks, namely thickened uterine lining, which has to be watched.

The Players:

  • Creams. Premarin and Estrace vaginal cream are the two main players here to know. Though expensive because they are brand names, the creams may still be less expensive than the rings or vaginal tablet. In some studies, Estrace and Premarin cream result in more symptoms like breast tenderness and may lead to more uterine lining thickening than tablets. The creams are inserted using an applicator once or twice a week, but talk to your doctor about frequency because it will depend on your symptoms.
  • Rings. There are two main players here: Femring and Estring. Femring is a higher dose estrogen than Estring so more tend to go with Estring. Women love the rings. Studies have shown women prefer the estradiol releasing vaginal ring, Estring, to Vagifem or Premarin cream for ease of use, comfort and satisfaction. Estring is expensive but remember 1 ring lasts for 90 days, so you place a ring inside the vagina and remove it 3 months later. Patients really love this continuous low dose vaginal estrogen and the ease of it.
  • Tablets. Vagifem 10 mcg tablets are the only player here. A vagifem tablet is inserted using a pre-loaded single use applicator and used daily for two weeks, then twice weekly. What is cool here is that it’s a dry tablet but as moisture permeates the tablet it is eroded and estradiol is released into the vagina.

All of the vaginal preparations work for the symptoms mentioned above. The differences here are ease of use, cost, what method of delivery you prefer just remember that creams are associated with more breast tenderness than the other choices.

Which do you prefer?

Dr O.

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