How you use vaginal oestrogen depends on which type you have.
Always follow the instructions from a pharmacist or GP, or the leaflet in the medicine packet.
Dosage
Your dose of vaginal oestrogen depends on the type of medicine you're using:
- vaginal tablets (Vagifem, Vagirux) - insert 1 tablet a day for 2 weeks, then 1 tablet twice a week (leave 3 or 4 days between each dose)
- vaginal gel (Blissel) - insert 1 dose of gel a day for 3 weeks, then 1 dose twice a week
- vaginal pessaries (Imvaggis) - insert 1 pessary a day for 3 weeks, then 1 pessary twice a week
- Ovestin vaginal cream - insert 1 dose of cream a day for up to 4 weeks, then 1 dose twice a week depending on your symptoms
Using vaginal oestrogen tablets
- Wash your hands and get yourself into a comfortable position. You can either stand up or lie down.
- Open the pack and remove the applicator. The tablet should already be inside it.
- Hold the applicator so 1 finger can press the applicator plunger.
- Insert the applicator carefully into your vagina. You can do this either standing up or lying down. Try to insert about half of the applicator and only go as far as you're comfortable with.
- Press the applicator plunger until you feel it click. This lets you know that the tablet has been released. The tablet will then attach itself to your vaginal wall.
- Gently remove the applicator and throw it away.
Using vaginal gel
Your gel will come in a tube. It will also come with a plunger and a small, empty tube (cannula) to help you insert the gel. It is best to use the gel just before bedtime.
- Wash your hands and remove the tube cap. If it's the first time you're using the tube, pierce the seal on the neck of the tube - but do not use it if the seal is broken.
- Insert the plunger into the cannula and screw the end of the cannula onto the neck of the tube.
- Squeeze the gel into the applicator until it reaches the filling mark. The plunger will stop at that mark.
- Unscrew the cannula from the tube and replace the cap on the tube.
- Get into a comfortable position, either standing up or lying down. Insert the end of the applicator into your vagina.
- Push the plunger all the way down.
- Gently remove the applicator. Throw the cannula away and rinse the plunger with warm clean water so you can use it again.
Using vaginal pessaries
It is best to use vaginal pessaries just before bedtime.
- Wash your hands and get yourself into a comfortable position, either standing up or lying down.
- Remove the pessary from its foil pack.
- Standing up or lying down, gently insert the pessary as far into your vagina as you can.
- Wash your hands.
Using vaginal cream
- Wash your hands and remove the cap from the tube. If it's the first time you're using the tube, pierce the seal on the neck of the tube - but do not use it if the seal is broken.
- Screw the end of the applicator onto the tube.
- Squeeze the cream into the applicator to the red ring mark. The plunger will automatically stop at that mark.
- Unscrew the applicator from the tube and put the cap back on the tube.
- Get into a comfortable position, either standing up or lying down. Gently insert the applicator into your vagina and push the plunger as far as it will go.
- Remove the applicator and take the plunger out of it. Wash the applicator and plunger in warm, soapy water so you can use it again.
How long to use it for
You'll usually be recommended to take HRT for between 2 and 5 years to relieve symptoms. But you may need to take it for longer. There is no set limit on how long you can take it.
It's recommended that you talk to your GP at least once a year. This is to check if the benefits of using vaginal oestrogen still outweigh the risks.
If you forget to use it
No matter what form of vaginal oestrogen you use, never insert 2 doses at the same time.
Never insert an extra dose to make up for a forgotten one.
If your GP has advised you to use vaginal oestrogen regularly and you often forget doses, it may help to set an alarm to remind you.
You could also ask a pharmacist for advice on other ways to help you remember to use your medicine.
Vaginal tablets and cream
Insert your missed tablet or dose of cream as soon as you remember.
Pessaries
If you forget to insert your pessary during your 3 weeks of daily treatment, skip the missed dose and then insert your next pessary at the usual time.
If you forget during twice-weekly use, insert the forgotten dose as soon as possible
Gel
Insert your missed dose of gel as soon as you remember, unless it's been over 12 hours since your last dose. In this case, wait until the next one.
If you insert too much
Inserting an extra dose of vaginal oestrogen is unlikely to harm you. If you're worried, talk to your GP or pharmacist for advice.
If you stop using it
Talk to your GP if you're thinking of stopping using vaginal oestrogen. They'll help you decide what's best for you. They may reduce your dose gradually, to help stop symptoms coming back.
Vaginal oestrogen and alcohol
You can drink alcohol while using vaginal oestrogen. But it may be helpful to cut down on alcohol during the menopause. This can reduce hot flushes and improve your sleep.