Choice of product

Estradiol vaginal 10 microgram tablet/pessaries should be prescribed generically, where possible. Where a branded product is to be prescribed, the following should be taken into account:

• Selection should be based on cost, patient preference, consideration of plastic waste, manual dexterity and cognitive impairment.

• Vagirux is a preferred sustainable option due to reduced plastic use compared with products supplied with single use applicators. Vagirux, is supplied with a reusable applicator, which can be washed in warm soapy water and air dried between uses. This helps to reduce disposable plastic waste. The applicator can be reused up to 24 times.

Currently estriol vaginal cream can be prescribed in two forms:

 

· Estriol 0.1% (Ovestin®) cream which contains 0.5mg estriol per 0.5g application

· Estriol 0.01% (formerly Ortho-Gynest®) cream which contains 0.5mg estriol per 5ml application

 

Despite Ovestin® 0.1% cream being 10 times stronger, the amount of cream delivered per application is 10 times less than that of Estriol 0.01% cream, meaning that both creams deliver an identical amount of estriol per application, that being 0.5mg.

 

Pessaries 6.5mg

 

Use restricted to the treatment of vulvovaginal or vaginal atrophy in postmenopausal women having moderate to severe symptoms, if vaginal oestrogen, or

non-hormonal moisturisers or lubricants have been ineffective or are not tolerated.