False Sense of Security with Topical Estrogen Creams (Premarin) & Vaginal Tablets (Vagifem)

Q. My doctor prescribed Premarin Cream for vaginal dryness. He said I wouldn’t absorb enough to be a problem. The paper insert that comes with the drug makes me question its safety, however. Is it absorbed into my body?

A. Premarin Vaginal Cream is absorbed through the vagina into the blood stream. It should be given the same respect as oral medicine.

We find it fascinating that health professionals and patients tend to believe that pills are absorbed but “topical” treatments that are applied to skin or body cavities somehow stay put and do not get into the blood stream. Over 30 years ago an article in the journal JAMA (Dec. 14, 1979) reported that vaginal estrogen cream could be absorbed quickly and efficiently into the blood stream.

In 2006 an article in the journal Annals of Oncology (April issue) confirmed that vaginal estrogen tablets (Vagifem) or creams are effective ways to get estrogen into the body.

Research published in the journal Menopause (Jan.-Feb. 2009) noted the following:

“The present data using validated, accurate, and sensitive mass spectrometry assays of estrogens show that the Vagifem pill and Premarin cream, after 1 week of daily treatment, cause an approximately fivefold increase in serum estradiol in postmenopausal women, thus indicating that the effects are unlikely to be limited to the vagina and that systemic actions are expected after application of these intravaginal estrogen preparations.”

A study in the journal Fertlity and Sterility (Nov. 2010) compared estrogen levels in blood after seven days of oral treatment (0.3 mg conjugated estrogens) and then after seven days of vaginal cream (0.5 grams). The women in the study had “severe atrophic vaginitis.” In other words, they were suffering from vaginal tissues that were quite dry. Although estrogen was clearly absorbed from the vaginal cream, levels in the bloodstream were one-third lower than after oral doses.

This finding might be quite reassuring except for the fact that the atrophic vaginitis might have affected absorption. It would be interesting to see what the absorption levels might be after several months (or years) of treatment. Once the atrophic vaginal tissues have healed they may be more susceptible to estrogen absorption.

Other Options for Vaginal Dryness:

It is clear that estrogen can be absorbed into the blood stream whether it is taken orally or intra-vaginally. That means that the benefits and risks of estrogen should be roughly comparable, regardless of the route of administration.

Many women would like to know what they can do, besides taking estrogen, to deal with vaginal dryness. There are a number of other options that can be considered. Visitors to this website have shared their experiences with non-traditional approaches:

Coconut Oil

“I have been using coconut oil for vaginal dryness for quite some time and find it solves the problem. I use it whenever I feel an irritation occurring. It can be applied manually with the finger but this does not always get it to the irritated spot. I use a plastic plunger-type applicator that came with a vaginal lubricant I bought on line.

“The coconut oil comes in a jar and turns to a liguid if kept in a warm location, but turns solid if in a cool location – not necessarily in the fridge. If you have the plunger, all you need to do is be sure the oil is fairly solid and use a clean spoon to pack it in the plunger – no problem.” Vonnie

Olive Oil

“We have been using olive oil for lubrication for some time now and it is great. It is better than any off the shelve lube that we have tried and it lasts a long time unlike many of the other popular lubrications which tend to dry up after several minutes. The consistency is very close to the natural lubrication and as far as we know there are no side affects with using olive oil.” B

Alove Vera Gel

“My husband and I can’t use KY Jelly or any other brand of lubricant we have tried. They make me itch and burn.

“We have found, though, that the slimy gel that oozes from aloe leaf when you break off a piece is a very good lubricant. I hope this will add to your uses of aloe vera and help another couple.”

You will find a number of other stories for easing vaginal dryness using olive oil and coconut oil on this website. Aloe vera gel should be more compatible with latex-based contraceptive protection such as condoms and diaphragms, when that is a consideration. Oils destroy latex.

Another solution to assist with vaginal dryness includes hyaluronic acid.

Our Guide to Menopause offers additional suggestions.

Share your own story below.