Vaginal preparations

• local oestrogens in the form of pessaries or cream, ring or tablets can help dyspareunia, atrophic vaginitis, or recurrent urinary tract infections
• topical oestrogens should be used in the minimum effective amount to minimise oestrogen absorption; if topical preparations are used long-term then some require oral progestogen for 10-14 days of each month to combat development of endometrial hyperplasia (1)

In the context of safety of usage of topical oestrogens, the Committee on Safety of Medicines has stated (2):

• topical oestrogens should be used in the lowest effective amount to minimise systemic absorption
• treatment should be interrupted at least annually to re-assess the need for continued treatment
• if break-through bleeding or spotting appears at any time on therapy, the reason should be investigated and may include endometrial biopsy to exclude endometrial malignancy

Reference:

1. BNF 7.2
2. Currrent Problems in Pharmacovigilance (2003), 29, 3.