Benign prostatic hyperplasia
USE OF VAGINAL ESTROGEN IN WOMEN
WITH PELVIC FLOOR DISORDERS
Patient Fact Sheet
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
There are two brands, Estrace™ and Premarin™.
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
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
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?
HOW TO USE IT: __________________________________
HOW LONG TO USE IT: ____________________________
Please discuss any questions you have
Flexibilidade e Precarização do Trabalho: A Experiência Brasileira Marcia de Paula Leite Cibele Saliba Rizek USP/São Carlos Prepared for delivery at the 1997 meeting of Latin America Studies Association Continental Plaza Hotel Guadalajara, Mexico April, 17-19, 1997 Flexibilidade e precarização do trabalho: A experiência brasileira Introdução A questão das no
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