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USE OF VAGINAL ESTROGEN IN WOMEN
WITH PELVIC FLOOR DISORDERS
Patient Fact Sheet
Introduction
For a woman who has already had breast cancer, her own Estrogen is a normal human hormone. Estrogen levels fall oncologist (cancer doctor) is probably the best person to advise quickly after menopause. In some younger women, they fall ear- her about whether vaginal estrogen use is safe for her. lier because of certain health conditions, medicines, or treatments.
Low levels of estrogen can cause uncomfortable problems, like hot What Are Other Choices If Vaginal Estrogen Is Not
flashes, vaginal dryness, or pain with sexual relations. Low levels can also cause more serious problems, like bone thinning (osteo- If a woman can’t or doesn’t want to use vaginal estrogen, porosis). Some women are prescribed added estrogen as treatment there are other choices to treat problems due to atrophy. For for these kinds of problems. Because estrogen use causes a small example, vaginal moisturizers or lubricants may help sexual dis- increase in the risk of blood clots or cancer of the breast or uterus, comfort. Repeated urinary tract infections may be helped with use of estrogen should always be carefully considered. antibiotics and cranberry products. If a pessary causes vaginalsores, the pessary can be left out until the sores heal. It is not yet Why Use Estrogen Vaginal Cream as a Treatment?
known whether or exactly how much vaginal estrogen might help When estrogen levels fall, the vagina and genital skin (the with things like healing after surgery. None of these other treat- area between the legs), begins to thin. It also becomes drier as the ments actually treats the atrophy itself. blood supply decreases. Support muscles weaken. We call thesechanges atrophy. Atrophy can increase problems like pain with Who Should Not Use Vaginal Estrogen?
sexual intercourse; urine urgency (a sudden, frequent need to pass Generally, women who are pregnant, have bleeding from the urine), burning, or bladder infection; incontinence (leaking urine vagina for an unknown reason, or have a history of breast cancer, or feces); and prolapse (dropping of the bladder, uterus, and/ or severe heart disease, stroke, or blood clots are advised to be espe- bowel). Atrophy can also make it harder to heal if surgery is need- cially careful about estrogen use. If you have any of these added ed. And for women who use a support pessary, atrophic vaginal health problems, it is often best to talk to all your providers before tissue is more likely to be injured by pressure from the pessary. Vaginal atrophy is caused by lack of estrogen, and vaginal estrogen can be an important part of care. Low doses of vaginal How Do You Use Vaginal Estrogen?
estrogen can help improve comfort, control, and healing. There are 3 choices, two are placed in the vagina at bedtime, What Do Experts Say About The Safety Of Vaginal
1. Cream: There are two brands, Estrace™ and Premarin™.
Estrogen?
With creams, you measure the dose into an applicator to insert Recent reports of small increases in rates of breast cancer, in your vagina at bedtime. Sometimes we also ask you to heart attack, or stroke in women using estrogen as a pill by mouth apply cream to the outside skin using your finger. Creams have worried many women. It is important to know that estrogen absorb easily, giving you the quickest comfort if you feel dry.
used vaginally in small amounts is different. However, creams are easier to over-use, and the easy absorp-tion means higher blood levels compared to other choices.
For many years, vaginal estrogen has been approved by the Creams are often used nightly to start and then used less often U.S. Food and Drug Administration to treat problems like dis- as atrophy lessens. They usually cost the least.
comfort with sex or urination, if they are caused by atrophy. In 2. Tablets: A vaginal pill (Vagifem™) is also typically used
2010, both the North American Menopause Society and the every night for 2 weeks and then twice a week. Each pill may Endocrine Society looked again at all the studies available, and have its own plastic throw-away inserter. Pills absorb more agreed that low dose vaginal estrogen is safe for most women, and slowly, and very little estrogen goes into your blood stream.
lessens sexual discomfort, urge-related urine loss, and urinary Some women say pills are less messy, but others say the pill tract infections, without increasing the risk of uterine cancer.
falls out if it is not placed deep in the vagina or if the vagina Although levels of estrogen in the blood may go up slightly with most vaginal estrogen use, levels stay much lower than those in 3. Ring: Another choice is a ring (Estring™) that is placed in the
women taking pills by mouth or having menstrual periods. This vagina and slowly releases vaginal estrogen over 3 months.
means a woman’s risk of blood clots, breast or uterine cancer is This provides a steady, very low level of estrogen. You can about the same whether she uses low dose vaginal estrogen or not. insert and remove the ring yourself, or your health care This material is for educational purposes only and should in no way be taken to bethe practice or provision of medical, nursing or professional healthcare advice or serv- For more information, contact:
ices.The information should not be used in place of a visit, call, consultation or adviceof your physician, nurse or other health care provider. The information obtained here- Society of Urologic Nurses and Associates
in is not exhaustive and does not cover all aspects of the specific disease, ailment, physical condition or their treatments. Should you have any health care related ques- tions, please call or see your physician, nurse or other health care provider promptly.
As a professional community of urologic nurses and associates, SUNA is committed to enrich- ing the professional lives of our members and improving the health of our patients and their families, through education, research, and evidence-based clinical practice.
2013 Society of Urologic Nurses and Associates provider can do this for you at an office visit. If you have anuntreated bulge or weak vaginal muscles, the ring may not stayin place.
How Long should Vaginal Estrogen Be Used?
Most vaginal estrogen studies to date have only followed women for 1 year, so we only know they are low risk for that peri-od of time. However, many post-menopausal women use theselow dose medications for many years. Some other women chooseto use them for a few months at a time or whenever they havesymptoms.
WHAT WOULD BE A GOOD CHOICE FOR YOU?
TYPE: ____________________________________________ HOW TO USE IT: __________________________________ HOW LONG TO USE IT: ____________________________ Please discuss any questions you have

Source: http://suna.inurse.com/download/members/vaginalEstrogen.pdf

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