What Are Some Alternatives to Estrogen Cream

A while back, you talked about using estrogen vaginally to treat the symptoms of vaginal atrophy. I decided to talk to my gynecologist, and she prescribed estrogen cream. The problem is the cream is really messy and I am not convinced it is staying in my vagina where I need it. Are there better options available?
—There Must Be a Better Way

I am so glad to hear that you are getting treatment for your vaginal symptoms! But I also hear your complaints about estrogen creams. They can be messy to apply, and if you can’t hang out on your back for an hour after applying them, it can seem like all that cream ends up in your underwear or on your sheets and not in your vagina where it can be helpful.

Estradiol creams can feel especially messy at first, because typically when you first start using them, you are supposed to apply them daily, before cutting back to twice weekly. While they can be messy, estradiol creams offer the greatest flexibility in dosing, so for some women, they may be the best choice.

However, you will be happy to hear that there is more than one form of vaginal estrogen. In addition to creams, there is a vaginal ring and vaginal estrogen tablets.

The ring — called Estring — is available in a single dose of 7.5 micrograms of estradiol daily. It is inserted once every 90 days. You can do it yourself or, if you are unable to, your doctor can insert it for you. After 90 days, you remove the old one and pop in a new one. This is a great option if you prefer minimal fuss, but the single dose may not be right for all women.

There are several vaginal estrogen tablets — sometimes also called vaginal inserts — available. Vagifem and Yuvafem are common brands, and generics are available. Like estradiol creams, you start out using them more often and after a couple of weeks settle into a twice-weekly dosing schedule.

The tablets come with applicators to assist with placing them properly. They come in two strengths, which allows for more flexibility in finding the right dose, but, like estradiol cream, they do involve more hands-on time than the ring, especially when getting started.

As with many medications, it can take some trial and error to find the vaginal estrogen dose and formulation that both alleviates your symptoms and works best for your lifestyle. I do think it is worthwhile to try some other options before resigning yourself to gloppy creams.