Which Type of Estrogen Hormone Therapy Is Right for You?
Estrogen Treatment: Topical Creams, Gels, and Sprays
What are they? Estrogen gels (like Estrogel), creams (like Estrasorb), and sprays (like Evamist) offer another way of getting estrogen into your system. As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. The specifics on how to apply these creams vary, although they're usually used once a day. Estrogel is applied on one arm, from the wrist to the shoulder. Estrasorb is applied to the legs. Evamist is applied to the arm.
Pros. Because estrogen creams are absorbed through the skin and go directly into the bloodstream, they're safer for people who have liver problems than oral estrogen.
Cons. Estrogen gels, creams, and sprays have not been well-studied. While they could be safer than oral estrogen, experts aren't sure. So assume that they pose the same slight risk of serious conditions, like cancer and stroke.
One potential problem with using this type of estrogen treatment is that the gel, cream or spray can rub or wash off before it's been fully absorbed. Make sure you let the topical dry before you put on clothes. Always apply it after you bathe or shower.
Because the estrogen is absorbed right through the skin, don't let other people in your family touch these creams or gels. If they do, they could get dosed with estrogen themselves. For the same reason, make sure your hands are clean and dry after applying the medication.
Estrogen Treatment: Vaginal Suppositories, Rings, and Creams
What are they? These types of estrogen treatments can be applied directly to the vaginal area. In general, these treatments are for women who are troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse. Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and insertable rings (Estring or Femring).
The exact dosing schedule varies, depending on the product. But in general, vaginal rings need to be replaced every three months. Vaginal tablets are often used daily for a couple of weeks; after that, you only need to use them twice a week. Creams might be used daily, several times a week, or according to a different schedule.
Pros. Studies have shown that when it comes to treating the vaginal symptoms of menopause -- like dryness -- these treatments are more effective than other forms of estrogen therapy. Like patches, some of these treatments might be more convenient than taking a pill each day.
Some vaginal suppositories and rings are low dose, and only affect the immediate area. The advantage is that they can relieve vaginal symptoms without exposing the entire body to high doses of estrogen. Theoretically, this could reduce the more serious risks of estrogen therapy -- and be a safe way for women who cannot take systemic therapy to get relief.
Cons. Suppositories and rings with low doses of estrogen only help with vaginal symptoms of surgical menopause. They won't help with other symptoms like hot flashes. And while higher dose suppositories, rings, and creams could help with these symptoms, they may expose you to the same risks as other types of estrogen therapy -- including a higher risk of stroke and cancer. Most doctors do not recommend long-term vaginal estrogen therapy to women who still have their uterus, because it may increase the risk of endometrial cancer.