Estradiol (Estrace) vaginal cream is used to lessen certain symptoms related to menopause, such as vaginal itching and dryness. It's a hormone replacement therapy that's made of estradiol, a form of estrogen. Estradiol (Estrace) vaginal cream is applied vaginally with an applicator. Typically, your gynecologist or healthcare professional (HCP) will prescribe it daily for a few weeks, and then lower the dose to a few times a week after that. Some side effects of estradiol (Estrace) vaginal cream include vaginal burning and irritation.
Treatment of vaginal itching, dryness, and burning due to menopause
Estradiol (Estrace) vaginal cream contains man-made estradiol, a form of estrogen that's naturally made in the body. During menopause, the body makes less estrogen, leading to symptoms such as vaginal dryness, itching, and burning. Estradiol (Estrace) vaginal cream is applied vaginally to help relieve vaginal symptoms of menopause.
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Only need to use it 1 to 3 times per week after your symptoms improve
Applied directly to the vagina where symptoms are occurring
Available as a lower-cost generic
Might be challenging and uncomfortable to use
Raises your risk for certain cancers, blood clots, and strokes
Some people might need to take it with another hormone called progestin
It's important to read the Patient Information before using estradiol (Estrace) vaginal cream to make sure you use it correctly.
Use the applicator that comes with estradiol (Estrace) vaginal cream to place the cream into your vagina, and don't use any other tool without asking your pharmacist or healthcare professional (HCP).
To measure your dose of estradiol (Estrace) vaginal cream, fill the applicator with the cream, keeping the plunger attached to the applicator. The plunger will start rising as cream is squeezed out of the tube, and you can read the markings on the plunger to measure the amount of grams for your dose.
Clean your estradiol (Estrace) vaginal cream applicator after every use by washing it with mild soap and warm water. Remember to remove the plunger from the applicator before cleaning. Don't wash with hot or boiling water as this might damage the applicator.
Check your breasts monthly for any abnormal changes, like changes in size, shape, or color. There's a small risk that using estradiol (Estrace) vaginal cream can raise the risk of breast cancer, so routine checks might help with early detection.
Estradiol (Estrace) vaginal cream only treats vaginal symptoms related to menopause, such as vaginal itching, dryness, and burning. If you're having other menopause symptoms, like hot flashes or night sweats, discuss other treatment options with your HCP because estradiol (Estrace) vaginal cream might not be the best choice for you.
Estradiol (Estrace) vaginal cream can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: People with a uterus | Using estradiol (Estrace) vaginal cream without progestin | Long-term use of estradiol (Estrace) vaginal cream | Higher doses of estradiol (Estrace) vaginal cream
There's a higher risk of endometrial cancer, or cancer in the uterine lining, in females who use estrogen products alone, like estradiol (Estrace) vaginal cream. The chances are higher in females who use estradiol (Estrace) vaginal cream for a long time at high doses. If you have a uterus, taking another hormone called a progestin along with estradiol (Estrace) vaginal cream can help lower your risk because progestin balances out estrogen's effects by slowing the growth of your uterine lining. If you have abnormal vaginal bleeding that doesn't go away or keeps coming back, let your healthcare professional (HCP) know because this can be a warning sign of uterine (endometrial) cancer.
Risk factors: Using estradiol (Estrace) vaginal cream with progestin | Long-term use of estradiol (Estrace) vaginal cream | Personal or family history of breast cancer
There's a higher risk of developing breast cancer in females using estradiol (Estrace) vaginal cream both alone and with progestin, especially when taking the medications long term. Lower your risk by working with your HCP to use the lowest dose possible over the shortest period of time. To help with early detection and to make sure there aren't any abnormal changes in your breasts, do monthly breast self-checks at home and yearly breast exams with your HCP. Call your HCP if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.
Risk factors: History of stroke | Personal or family history of blood clots in the veins | Postmenopausal women using estrogen products | Identified as obese | History of lupus | Using estradiol (Estrace) vaginal cream with progestin | Long-term use of estradiol (Estrace) vaginal cream | Inactivity
There's a higher risk for stroke, blood clots in the lungs (pulmonary embolism), and blood clots in the legs (deep vein thrombosis) in postmenopausal women aged 50 to 79 years who use estradiol (Estrace) vaginal cream alone or with progestin. Get emergency help right away if you have any signs of a blood clot in the legs (cramps, swelling, pain, or muscle tightness) and lungs (trouble breathing, chest pain, or cough). If you have any symptoms of a stroke, such as weakness or numbness of the arms, legs, or face on one side of the body, slurred speech, blurred vision, headache, dizziness, loss of balance, trouble walking, or confusion, get emergency help right away.
Risk factors: History of heart attack | Heart disease | High blood pressure | High cholesterol | Diabetes | Identified as obese | Smoking tobacco
Estradiol (Estrace) vaginal cream shouldn't be used alone or in combination with progestin to lower the chances of heart disease. Chances of having a heart attack are higher in postmenopausal women between the ages of 50 to 79 years who use estradiol (Estrace) vaginal cream alone or with progestin. If you have any signs of a heart attack, such as chest pain, chest tightness, trouble breathing, nausea, vomiting, dizziness, sweating, or a fast heartbeat, get emergency help right away.
Risk factors: Age 65 or greater | Using estradiol (Estrace) vaginal cream alone or with progestin
Estradiol (Estrace) vaginal cream shouldn't be used to lower the risk of dementia. The chances of developing dementia are higher in women over the age of 65 who use estradiol (Estrace) vaginal cream alone or with progestin. If you or your loved one notices that you're becoming forgetful, confused, anxious, or are having a hard time making decisions or solving problems, let your HCP know.
Risk factors: Postmenopausal women using estrogen products | History of gallbladder problems | History of liver problems with past estrogen use or with pregnancy
There's a higher risk of gallbladder problems in postmenopausal women using estradiol (Estrace) vaginal cream, with some requiring surgery. Also, since estradiol (Estrace) vaginal cream is mostly broken down in the liver, people with liver problems might have higher levels of medication in their body, which can lead to a greater risk of side effects.
Talk to your HCP if you have any gallbladder or liver conditions or if you notice symptoms such as stomach pain or swelling, back pain, shoulder pain, dark urine, yellowing of your skin and eyes (jaundice), loss of appetite, nausea, or vomiting.
Risk factors: History of breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Using estradiol (Estrace) vaginal cream can lead to very high calcium in women with breast cancer and in those whose cancer has spread to their bones. If your calcium is high, you might feel thirsty, have stomach pain, nausea, vomiting, constipation, bone pain, muscle weakness, or confusion. Tell your HCP if you have any of these symptoms because you might have to stop using estradiol (Estrace) vaginal cream.
Use estradiol (Estrace) vaginal cream carefully if you have low parathyroid hormone levels (hypoparathyroidism). Hypoparathyroidism is a condition that affects the glands in the back of your neck and leads to low calcium in your blood. Let your HCP know if you have signs of low calcium such as burning or tingling of your fingers, toes, or lips, muscle pain and cramps, or confusion.
A blood clot that blocks part of your eye, known as retinal vascular thrombosis, can develop in women using estrogen products, like estradiol (Estrace) vaginal cream. If you suddenly can't see out of one or both eyes or if you have bulging eyes, double vision, or migraines, stop using estradiol (Estrace) vaginal cream and call your HCP.
Risk factors: History of high triglycerides
Estradiol (Estrace) vaginal cream can raise triglyceride levels in your blood, which can lead to serious conditions like inflammation of the pancreas (pancreatitis). If you have a history of high triglycerides, which is a type of body fat that mostly comes from foods, try dietary changes, like limiting salt and sugar, avoiding alcohol, and eating more fruits, vegetables, whole grains, lean meats, beans, and nuts. For more guidance on how to reduce your triglyceride levels, ask your HCP.
Risk factors: Low thyroid hormone levels
Estradiol (Estrace) vaginal cream can affect thyroid hormone levels in your blood. If you take medications for low thyroid hormone levels, you might require higher doses of thyroid replacement therapy. Your HCP might have you get regular blood tests to check your thyroid hormone levels.
Risk factors: History of heart or kidney problems
Using estrogen products, like estradiol (Estrace) vaginal cream, might cause some fluid retention, or edema, and chances are higher in people with heart conditions (e.g., congestive heart failure) or kidney damage. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your HCP know.
Risk factors: History of asthma or diabetes | History of lupus | History of seizures or migraines | History of hereditary angioedema | Taking other medications that can cause seizures
Dosage | Quantity | Price as low as | Price per unit |
---|---|---|---|
42.5g of 0.01% | 1 tube | $339.32 | $339.32 |
The typical starting dose is 2 to 4 grams inserted vaginally daily for one or two weeks. Then, your HCP will lower the daily dose by half, and ask you to apply it for another one or two weeks.
After you've experienced some improvement in symptoms, the typical maintenance dose is 1 gram applied vaginally one to three times per week.
Abnormal vaginal bleeding
Breast cancer
Tumor that depends on estrogen for growth
Blood clots or blood clotting conditions
History of stroke or heart attack
Liver problems
Currently pregnant
Treatment of vaginal itching, dryness, and burning due to menopause
Hot flashes and night sweats due to menopause
Vaginal itching, dryness, and burning due to menopause
Low estrogen levels
Breast cancer or prostate cancer in certain people
To prevent bone loss (osteoporosis) after menopause
Vaginal dryness, thinning, and irritation caused by menopause - generic estradiol, Vagifem, and Yuvafem
Moderate-to-severe painful sex due to vaginal dryness and thinning caused by menopause - Imvexxy only
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Allergan, Inc. (2023). ESTRACE- estradiol cream [package insert]. DailyMed.
Fong, J., et al. (2012). Hypocalcemia. Canadian Family Physician.
Hirschberg, A.L., et al. (2021). Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide. Maturitas.
Kongnyuy, E.J., et al. (2000). Hormone replacement therapy has no effect on body weight and cannot prevent weight gain at menopause. Cochrane.
MedlinePlus. (2022). Hypoparathyroidism.
North American Menopause Society. (2024). News You Can Use About Hormone Therapy.
Orzolek, I., et al. (2022). Estrogens, Cancer and Immunity. Cancers.
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