Vaginal atrophy in postmenopausal women
▶INITIALLY BY VAGINA USING VAGINAL CREAM, OR BY VAGINA
USING VAGINAL GEL
▶Adult: Apply 1 applicatorful daily for 3–4 weeks, then
(by vagina) reduced to 1 applicatorful twice weekly, to
be applied at bedtime, treatment should be evaluated
after 12 weeks
Vaginal atrophy in postmenopausal women
▶INITIALLY BY VAGINA USING PESSARIES
▶Adult: 1 pessary daily for 3 weeks, then (by vagina)
1 pessary twice weekly, to be inserted at bedtime
OVESTIN ®
Vaginal surgery for prolapse when there is epithelial
atrophy in postmenopausal women (before surgery)
▶BY VAGINA
▶Adult: Apply 1 applicatorful daily for 2 weeks before
surgery, resume 2 weeks after surgery
DOSE EQUIVALENCE AND CONVERSION
▶For Ovestin ® cream, 1 applicatorful contains
500 micrograms estriol; for Blissel ® gel, 1 applicatorful
contains 50 micrograms estriol; for Imvaggis ® pessary,
1 pessary contains 30 micrograms estriol.
PDF page 899
Active arterial thromboembolic
disease (e.g. angina or myocardial infarction). history of
breast cancer. history of venous thromboembolism.
oestrogen-dependent cancer. recent arterial
thromboembolic disease (e.g. angina or myocardial
infarction). thrombophilic disorder. undiagnosed vaginal
bleeding. untreated endometrial hyperplasia
PDF page 900
Acute porphyrias p. 1120. diabetes (increased
risk of heart disease). factors predisposing to
thromboembolism. history of breast nodules—closely
monitor breast status (risk of breast cancer). history of
Genito-urinary system
endometrial hyperplasia. history of fibrocystic disease—
closely monitor breast status (risk of breast cancer).
hypophyseal tumours. increased risk of gall-bladder
disease. migraine (or migraine-like headaches). presence
of antiphospholipid antibodies (increased risk of
thrombotic events). prolonged exposure to unopposed
oestrogens may increase risk of developing endometrial
cancer. review treatment at least annually to assess need
for continued treatment. risk factors for oestrogen-
dependent tumours (e.g. breast cancer in first-degree
relative). symptoms of endometriosis may be exacerbated
. uterine fibroids may increase in size
CAUTIONS, FURTHER INFORMATION
▶Risk of endometrial cancer The increased risk of endometrial
cancer depends on the dose and duration of oestrogen-
only HRT.
▶Risk of ovarian cancer Long-term use of combined HRT or
oestrogen-only HRT is associated with a small increased
risk of ovarian cancer. This excess risk disappears within a
few years of stopping.
▶Risk of venous thromboembolism Women using combined or
oestrogen-only HRT are at an increased risk of deep vein
thrombosis and of pulmonary embolism especially in the
first year of use.
In women who have predisposing factors (such as a
personal or family history of deep vein thrombosis or
pulmonary embolism, severe varicose veins, obesity,
trauma, or prolonged bed-rest) it is prudent to review the
need for HRT, as in some cases the risks of HRT may
exceed the benefits.
Travel involving prolonged immobility further increases
the risk of deep vein thrombosis.
▶Risk of stroke Risk of stroke increases with age, therefore
older women have a greater absolute risk of stroke.
Combined HRT or oestrogen-only HRT increases the risk
of stroke.
▶Risk of coronary heart disease HRT does not prevent coronary
heart disease and should not be prescribed for this
purpose. There is an increased risk of coronary heart
disease in women who start combined HRT more than
10 years after menopause. Although very little information
is available on the risk of coronary heart disease in
younger women who start HRT close to the menopause,
studies suggest a lower relative risk compared with older
women.
PDF page 900
