Hormone Replacement Therapy

Topical Hormone Replacement Therapy: Oestrogen Cream

Oestrogen cream is used to alleviate vaginal symptoms induced by menopause such as: dryness, irritation or itching (atrophic vaginitis) as well as improving vaginal tissue pre and post vaginal surgery.

The cream has an active ingredient called estriol, which naturally occurs in the female sex hormone, oestrogen and works as a supplement to replace the declining levels of oestrogen in the body. In the duration up to menopause the ovaries produce smaller and smaller amounts of oestrogen, which in turn decreases levels of oestrogen in the blood. A deficiency in oestrogen can lead to undesirable symptoms such as: vaginal dryness, itching or inflammation — potentially leading to painful intercourse and a greater likelihood of contracting urinary or vaginal infections.

Your practitioner will give you specific instructions in regards to the amount of cream to use and how often you must use it. The oestrogen cream can be directly applied in the vagina with the aid of a provided applicator. If you neglect to apply the oestrogen cream when it is due, apply it as soon as you remember. If you remember more than 12 hours after it was due you must simply miss the dose and continue to apply your next dose when it is due. Do not apply a double dose of oestrogen cream to compensate for a missed dose.

Small amounts of oestrogen are released into the vaginal tissues to provide short-term alleviation of menopause-related symptoms. Noticeable results may take several days or weeks of treatment.

The side effects listed below have previously been associated with this treatment. If you do experience symptoms listed here or other worrisome symptoms visit your doctor or pharmacist. Individuals who use this medication will not necessary experience any of the following side effects:

  • Vaginal irritation or itching after applying the cream
  • Vaginal discharge
  • Vaginal bleeding or spotting
  • Nausea and vomiting
  • Breast tenderness or pain
  • Headaches
  • Abdominal pain
  • Rise in blood pressure
  • Gall bladder disease
  • Skin reactions such as rash and itch
  • Irregular brown patches on the skin, usually of the face (chloasma)
  • Premenstrual-like symptoms
  • Depression
  • Disturbance in liver function
  • Blood clots in the blood vessels (e.g., deep vein thrombosis, pulmonary embolism, heart attack, stroke)


The side effects listed here may not incorporate the possible side effects that have been reported by the manufacturer of the oestrogen cream you may use. Please read the information provided with your cream or consult your doctor or pharmacist in order to be aware of other possible side effects or risks.

  • You have a history of breast cancer
  • Untreated thickening of the lining of the womb (endometrial hyperplasia)
  • Abnormal vaginal bleeding
  • You currently have blood clotting deep in the vein (deep vein thrombosis) or in the lungs (pulmonary embolism) or a past history
  • Recently had a heart attack
  • Recently had a stroke induced by a blood clot
  • You suffer from angina pectoris
  • A past history or active liver disease whereby your liver function has not recovered
  • You are pregnant
  • You are breastfeeding
  • Hereditary (inherited through genetics) blood disorders (porphyrias)
  • Have an allergic reaction to any of the ingredients contained in oestrogen cream
  • You have previously experienced allergic reactions when using oestrogen cream

Immediately cease use of this treatment and inform your doctor or pharmacist if you experience any allergic reactions.

  • There is a possibility that oestrogen cream can increase the risk of developing cancer of the lining of the womb if used over a long period of time. This can be monitored by careful observation whereby if you notice any vaginal bleeding or spotting, vaginal discomfort during or after using oestrogen cream or vaginal discharge consult a doctor so the issue can be investigated.
  • Women who use oestrogen as a hormone replacement therapy (HRT) are more susceptible to developing breast cancer in comparison to women who do not use HRT. Regular breast examinations by you and your doctor as well as mammograms are advised in order to monitor any cancerous activity.
  • HRT users have an increased risk of deep vein thrombosis, pulmonary embolism and stroke when compared to non-HRT users, especially if: you have a personal or family history, smoke, are overweight or have certain blood disorders.
  • The risk of blood clots developing in the veins while using HRT are also increased if you have been through major trauma, surgery or have been immobile for long amounts of time (e.g. travelling on a plane for more than three hours).
  • This cream can potentially degrade latex condoms, diaphragms and caps which renders them less effective at preventing STIs or pregnancy.

You experience symptoms such as:

  • Stabbing pains, swelling in one leg, pain when breathing or coughing, coughing up blood, sudden chest pain, breathlessness, numbness affecting a part of the body or one side of the body, fainting, increased severity of epilepsy, migraine or severe headaches, severe abdominal pain, increased blood pressure, itching of the whole body, yellowing of the skin or eyes (jaundice) or extreme depression.

You have:

  • A close family history of breast cancer (eg. mother, sister or grandmother)
  • Benign breast lumps (fibrocystic breast disease)
  • A history of fibroids in the womb
  • A history of endometriosis
  • A history of overgrowth of the lining of the womb (endometrial hyperplasia)
  • A personal or family history of blood clots in the veins
  • A personal or family history of recurrent miscarriage
  • A long-term condition called systemic lupus erythematosus (SLE)
  • A history of liver disease, e.g., liver cancer.
  • High blood pressure (hypertension)
  • Raised levels of fats called triglycerides in the blood (hyper-triglyceridaemia).
  • Decreased kidney function.
  • Heart failure.
  • A history of gallstones.
  • A history of migraines or severe headaches.
  • A history of an ear disorder that may cause hearing loss (otosclerosis).
  • History of irregular brown patches appearing on the skin, usually on the face, during pregnancy or during previous use of hormone preparations such as contraceptive pills (chloasma).

Or if you are taking medication in order to prevent blood clotting (anticoagulants) e.g., warfarin, highly overweight, or you smoke, or suffer from asthma.

Since oestrogen cream is absorbed into the bloodstream in small amounts it is less likely that other medicines will be affected e.g. oral or injected medicine. With this in mind, it is still highly important that you inform your doctor or pharmacist of medication you are already taking before commencing treatment; this includes over the counter medication as well as herbal medicines. Also consult your pharmacist or doctor before you start any new medication while using oestrogen cream in order to make sure the medicines can safely mix.

The following medications have the potential to increase the breakdown of oestrogen cream, potentially rendering it less effective and resulting in a reoccurrence of irregular bleeding or symptoms:

  • Barbiturates such as amobarbital
  • Carbamazepine
  • Efavirenz
  • Griseofulvin
  • Phenobarbital
  • Phenytoin
  • Primidone
  • Nevirapine
  • Rifabutin
  • Rifampicin
  • The herbal remedy St John’s wort (Hypericum perforatum).


If you require other vaginal medication (e.g. pessaries or vaginal cream) for vaginal infections, consult your doctor as they may opt to discontinue your use of oestrogen cream while treating the other vaginal infection(s).