Ovestin

Ovestin contains estriol, a naturally occurring short-acting oestrogen, and is used primarily to treat vaginal and urinary symptoms associated with oestrogen deficiency after the menopause.

These symptoms include vaginal dryness, itching, discomfort during intercourse, and recurrent urinary tract infections. Ovestin is available as a vaginal cream and as tablets.

Estriol acts locally on the vaginal and urethral tissues, restoring thickness, moisture, and elasticity to the vaginal lining and supporting the normal acidic environment that helps protect against infections.

Because estriol is a weak, short-acting oestrogen, systemic absorption is minimal when it is used vaginally at recommended doses, which distinguishes it from more potent oestrogens used in systemic HRT.

Ovestin vaginal cream is particularly useful for women who wish to treat localised symptoms without the wider hormonal effects of systemic therapy.

It can also be prescribed alongside systemic HRT if vaginal symptoms have not fully responded to oral or transdermal treatment alone.

For the vaginal cream, insert one applicatorful (0.5 mg estriol) into the vagina once daily at bedtime for the first two to three weeks, then reduce to twice weekly as a maintenance dose.

Wash the applicator after each use. For tablets, take one tablet daily with water.

It is best to apply the cream at bedtime, as lying down helps the cream stay in contact with the vaginal tissues. Use the lowest effective dose for the shortest duration required.

Your prescriber will review your treatment periodically to ensure continued benefit.

Vaginal cream: one application (0.5 mg estriol) daily for two to three weeks, then one application twice weekly for maintenance. Oral tablets: typically 0.

5 mg to 3 mg daily for the first few weeks, reducing to 0.5 mg to 1 mg daily. Dosing should be individualised. The goal is to use the minimum dose that controls symptoms adequately.

Common local side effects of the vaginal cream include mild vaginal irritation, itching, or discharge during the first few days of use.

These effects usually settle as the vaginal tissues respond to treatment. Breast tenderness and nausea are uncommon with vaginal estriol at standard doses due to low systemic absorption.

Rare side effects may include headache and fluid retention. With oral estriol, systemic effects are more likely and include nausea, breast discomfort, and spotting.

Even though vaginal estriol has minimal systemic absorption, inform your prescriber if you have a history of breast cancer, endometrial hyperplasia, or thromboembolic disease, as the risks and benefits must be carefully weighed.

Report any unexpected vaginal bleeding. Women using Ovestin cream long-term should have periodic reviews.

The cream base may weaken latex condoms and diaphragms; consider alternative barrier methods during treatment.

Ovestin is contraindicated in women with known or suspected breast cancer, oestrogen-dependent tumours, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, active or recent venous thromboembolism, active arterial thromboembolic disease, acute liver disease, porphyria, or known hypersensitivity to estriol or any excipient in the formulation.