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Update on local oestrogen use

17 May, 2017
I received a newsletter from HealthEd with an overview on Vaginal Atrophy and Sexual Function. If you have been prescribed local oestrogen please take note of the Take Home Messages below. I will attempt to get permission to post the whole document as it is very interesting with video inks from a variety of experts in the Menopause. For Women’s Health Physiotherapists who follow my blog, it is important to note the advice regarding application of local oestrogen.
For my patients, as you are aware, I have been encouraging you recently to dispense a small amount of Ovestin cream on your finger -halve one of the doses every second night as this means you lose less and you can avoid using the applicator (which is impossible to clean) and use a finger to apply. Squeeze the cream on your finger, insert low in the vagina – away from the cervix and be sure its on anterior wall and less deep– the half dose also means you don’t lose as much and this will be easier for any arthritic-fingered patients who were worried they couldn’t reach deep enough.
 
Vaginal Atrophy and Sexual Function
DR JOHN EDEN MB BS MD FRCOG FRANZCOG CREI
Dr John Eden is a certificated reproductive endocrinologist and gynaecologist. He is a Conjoint Associate
Professor at The University of New South Wales in Sydney. He is a visiting medical officer at the Royal
Hospital for Women, Sydney, Australia where he is Director of the Sydney Menopause Centre and the
Barbara Gross Research Unit
 
Take Home Messages
  • There is considerable data to support the use of topical oestrogens in urogenital atrophy.
  • Topical oestrogens should not be deposited deep in the vagina, but rather in the anterior portion, in order tominimise uterine exposure and to maximise the effect on the vulva, urethra and clitoral areas.
  • Oestrogen creams may be best used by abandoning the applicator all together and placed on a finger instead. This is then inserted inside the anterior vagina; some cream should also be smeared onto the vulval skin.
  • Patients who have had breast cancer should use nonhormonal moisturisers first and topical oestrogen as a last-resort.
  • Vulval dryness may respond to soap-free washes, using plain moisturisers on the vulva and intravaginal moisturiser products. Natural oils (such as coconut oil or olive oil) can be effective lubricants.
I will attempt to keep updating this.
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3 Comments
  1. Belinda permalink

    I was told to stop oestrogen for two months before a knee replacement op. It went septic and I was on I V antibiotics for weeks. The damage to my vulva was phenomenal, the inner labia atrophied to two little bumps on either side and the whole area was raw and red. It has taken a long time to get back to normal with anything I applied causing inflammation. I found fissan bottom cream to be the best barrier cream.

    • Yes the vagina and vulval area can suffer when oestrogen is withdrawn- are you from Australia Belinda? I’m not familiar with fissan cream.

      • Belinda permalink

        I’m in South Africa. I looked on the tube but there are no ingredients listed. The manufacturer is Unilever.

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