estriol at a glance
Medicine class
Local oestrogen-only hormone replacement therapy
Main role
Relieves postmenopausal symptoms of vaginal atrophy
How it is used
Inserted into the vagina as a cream or pessary
Systemic exposure
Substantially lower than with systemic HRT
What is estriol used for?
These products are licensed for local vaginal use after the menopause.
Treatment of vaginal atrophy caused by oestrogen deficiency, including dryness, irritation and discomfort.
Selected prescription cream and pessary products are also licensed around vaginal surgery.
Ovesse is specifically licensed for postmenopausal women aged 50 or over who have had no period for at least one year.
How does estriol work?
Estriol binds to oestrogen receptors in vaginal and urinary tissues. It helps restore the thickness and moisture of the vaginal lining, supports normal lactobacilli and moves vaginal acidity towards its usual range.
estriol preparations and strengths
Cream
Route: Cutaneous
Strengths: 1 mg/g, 0.01% w/w
Pessary
Route: Vaginal
Strengths: 0.03 mg, 0.5 mg
Vaginal cream
Route: Vaginal
How to take estriol
Use only inside the vagina and follow the instructions supplied with the formulation.
Wash your hands before and after use.
Insert cream gently using the supplied applicator. Wash reusable applicator parts in hot soapy water, rinse well and do not boil them.
Remove a pessary from its wrapper and insert it deeply into the vagina with a finger.
Some vaginal oestrogen creams can affect barrier contraception; ask about compatibility with condoms or diaphragms.
estriol side effects
Common or expected effects
- Local burning, irritation or itching
- Headache
- Breast tenderness or discomfort
- Abdominal or vaginal discomfort
- Vaginal bleeding or spotting
- Pain or burning when passing urine
- Nausea
Get urgent medical advice
- Severe allergic reaction, including facial or throat swelling and breathing difficulty
- Chest pain with breathlessness, or one-sided leg pain and swelling
- Stroke symptoms such as facial droop, arm weakness or speech difficulty
- Unexpected, persistent or heavy vaginal bleeding
- A new breast lump or other concerning breast change
- Jaundice or a new migraine-type headache
estriol in pregnancy
Estriol vaginal products are not indicated during pregnancy. If pregnancy is suspected or confirmed, stop using estriol and contact the prescriber. Available epidemiological data have not linked inadvertent exposure with fetal harm.
estriol while breastfeeding
Evidence during breastfeeding is limited, and these products are not indicated during lactation. Oestrogen may enter breast milk and reduce milk production, so vaginal estriol should generally be considered only following specialist advice.
estriol interactions
Important interactions are uncommon because systemic absorption is limited, but disclose all medicines and vaginal products.
Other locally applied vaginal treatments
Using products together may alter local absorption, tolerability or effectiveness.
Carbamazepine, phenytoin, rifampicin, rifabutin, nevirapine and efavirenz
These may increase oestrogen metabolism, potentially reducing estriol's effect or changing bleeding patterns, although relevance with vaginal use is uncertain.
Common questions about estriol
Answers are fully visible for fast scanning and source review.
Is estriol the same as systemic HRT?
No. Vaginal estriol is local HRT: most of its effect is within vaginal tissues, although some reaches the bloodstream.
Does estriol treat hot flushes or night sweats?
Vaginal estriol is intended for local vaginal symptoms and is not expected to treat general menopausal symptoms.
Does estriol require progesterone as well?
Routine additional progestogen is not recommended with these low-systemic-exposure vaginal products. Continued treatment and unexpected bleeding still require review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.