Estol

Indications

Estriol is a natural type of oestrogen (female hormone). It is used mainly to relieve symptoms of vaginal dryness, itching, burning and pain during sex caused by low oestrogen after menopause (vaginal atrophy). It may also be used to help reduce repeated urinary infections in post menopausal women, and before or after some vaginal operations. It is available as tablets, vaginal cream or pessaries.

How It Works

After menopause the body makes much less oestrogen, so the lining of the vagina and urinary passage becomes thin, dry and easily irritated. Estriol replaces some of this oestrogen. It helps the lining become thicker, moister and healthier and restores the normal acidity that protects against infection. Estriol is a weaker, short acting oestrogen compared with others.

Dosage and Administration

The dose and form depend on the problem being treated and are decided by your doctor. Use as prescribed. Treatment usually starts with daily use for a few weeks and is then reduced to a lower maintenance dose, such as twice a week. Vaginal cream or pessaries are best used at bedtime. Your doctor will review the need for treatment regularly, usually every 3 to 6 months.

Interactions

Medicines that speed up liver enzymes, such as Rifampicin, Carbamazepine, Phenytoin and St John's Wort, may reduce its effect. Estriol may increase the effect of steroids such as Prednisolone and some medicines such as Theophylline or Ciclosporin. Vaginal products can weaken latex condoms.

Contraindications

• Known, past or suspected breast cancer, or other oestrogen dependent cancer such as cancer of the womb lining.
• Unexplained vaginal bleeding.
• Untreated thickening of the womb lining (endometrial hyperplasia).
• Current or past blood clots in the legs or lungs, or a clotting disorder.
• Recent heart attack, stroke or angina.
• Active liver disease, porphyria or allergy to Estriol.

Side Effects

Mild effects may include local irritation, itching or burning (especially at the start), breast tenderness, vaginal discharge, nausea and spotting. These usually settle.

Get urgent medical help if you notice any vaginal bleeding after menopause, a lump in the breast, painful swelling of one leg, sudden chest pain or breathlessness, severe headache, weakness on one side of the body, problems with speech or vision, or yellowing of the skin or eyes.

Pregnancy and Lactation

Estriol is not used in pregnancy or while breastfeeding. If you become pregnant during treatment, stop and contact your doctor.

Precautions and Warnings

Hormone treatment after menopause should use the lowest effective dose for the shortest time. Have regular check ups and breast examinations as advised. Tell your doctor if you have high blood pressure, diabetes, migraine, epilepsy, gallstones, liver disease, endometriosis, fibroids or a family history of breast cancer or blood clots. Stop treatment and tell your doctor before planned surgery or long bed rest.

Overdose

Overdose is unlikely to be dangerous. It may cause nausea, vomiting or vaginal bleeding. Contact a doctor if a large amount is swallowed, especially by a child.

Therapeutic Class

Oestrogen (female sex hormone); hormone replacement for vaginal atrophy.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Do not freeze the cream.