Estriol topical
What is estriol topical?
Estriol cream is identical to a female hormone, estrogen. It is used to treat symptoms associated with menopause. This topical preparation helps to treat vaginal burning, dryness and itching caused due to a lack of estrogen.
Ovestin is used:
- For vaginal problems caused by having too little ‘oestrogen’
- Before or after vaginal surgery to help wound healing
What should my health care professional know before I take this medicine?
They need to know if you have any of these conditions:
- Known hypersensitivity to estriol or any of the excipients.
- Known, past or suspected cancer of the breast
- Known or suspected oestrogen-dependent malignant tumours (eg endometrial cancer)
- Undiagnosed genital bleeding
- Untreated endometrial hyperplasia
- Previous or current venous thromboembolism (deep venous thrombosis, pulmonary embolism)
- Known thrombophilic disorders (eg protein C, protein S, or antithrombin deficiency, see section 4.4)
- Active or recent arterial thromboembolic disease (eg angina, myocardial infarction)
- Acute liver disease, or a history of liver disease as long as liver function tests have failed to return to normal
- Porphyria
How should I take this medicine?
Remove the cap from a new tube and use the top of the cap to pierce the metal seal on the tube.
One end of the applicator is fitted with a plunger. Ensure the plunger is fully inserted into the applicator. Screw the other end of the applicator onto the tube. Squeeze the tube, so that the barrel of the applicator fills with cream. Unscrew the applicator and replace the cap on the tube.
Lie down, with knees bent and spread apart. Gently insert the open end of the applicator well into the vagina. Push the plunger firmly but gently as far as it will go to empty the cream into the vagina.
Keeping the plunger pressed down firmly, grip the applicator by the barrel and remove it.
What may interact with this medicine?
The metabolism of oestrogens may be increased by concomitant use of substances known to induce drug metabolising enzymes, specifically CYP 450 enzymes, such as anticonvulsants (eg phenobarbital, phenytoin, carbamazepine) and anti-infectives (eg rifampicin, rifabutin, nevirapine, efavirenz) and also bosentan.
Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones. Herbal preparations containing St. John's Wort (Hypericum perforatum) may induce the metabolism of oestrogens. With intravaginal administration, the first-pass effect in the liver is avoided and thus, estriol given intravaginally might be less affected by enzyme inducers than oral hormones.
Clinically, an increased metabolism of oestrogens may lead to decreased effect and changes in the uterine bleeding profile.
Contact between contraceptive diaphragms or condoms and the cream must be avoided since the rubber may be damaged by this preparation.
Oestrogen-containing oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine when co-administered due to induction of lamotrigine glucuronidation. This may reduce seizure control. Although the potential interaction between oestrogen-containing hormone replacement therapy and lamotrigine has not been studied, it is expected that a similar interaction exists, which may lead to a reduction in seizure control among women taking both drugs together. Therefore, dose adjustment of lamotrigine may be necessary.
What side effects may I notice from this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
Breast pain, micturition frequency increased, vaginal discharge, cystitis, leg pain, pre-menstrual tension, lower abdominal pain, palpitations and depression.
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