According to Western Medicine, vulvodynia has no identifiable cause and cure. However, doctors along with those affected admit that there are several possible causes for it to flare up. And hormonal imbalance is among one of them.

If hormones happen to be one of the culprits of your pain, then topical hormonal therapy, like estrogen cream, might be an effective vulvodynia treatment option for you.

#1: What Are Hormones?

Hormones are chemical messengers in your body produced by endocrine glands. They control most of your major bodily functions and processes like development and growth, metabolism, sexual functions, reproduction, and even cognitive functions and mood.

One of the hormone-producing glands responsible for female hormonal imbalance related problems are the ovaries. They secrete estrogen, testosterone, and progesterone – the female sex hormones.

#2: What Is Estrogen?

Estrogen is the primary female sex hormone that helps develop and maintain female organs, the female reproductive system, and secondary female sex characteristics.

#3: Estrogen for Vulvar and Vaginal Health

Estrogen is extremely important in keeping the female reproductive system healthy. When the estrogen level lowers, the vaginal and vulvar world can suffer from various painful symptoms.

Low estrogen symptoms include:

  • Stinging, itching and burning vulvar sensations
  • Dryness and soreness of the vagina
  • Increased urge to urinate
  • Burning pain while urinating
  • Increased number of urinary tract infections
  • Pain during sexual intercourse
  • Decreased vaginal lubrication

These above-mentioned symptoms (apart from being pretty identical to vulvodynia symptoms!) are usually experienced by menopausal and post-menopausal women and are called genitourinary syndrome of menopause (GSM). Because of this, medically, these women are usually a primary group to receive estrogen therapy.

#4: Estrogen Cream for Vulvodynia

Estrogen therapy also appears to be an effective vulvodynia treatment option, apart from being an effective solution for menopause symptoms.

However, women suffering from vulvodynia don’t have to undergo full hormonal therapy, as they don’t suffer from other menopausal symptoms like hot flashes and night sweats.

That is why the main product used for vulvodynia is a low-dose estrogen vaginal cream used externally (outside of the vagina).

Concentrated application speeds up hormone delivery to the affected vulvar area and reduces the possible side effects, by minimizing the absorption of the hormone in the rest of the body.

Low-dose topical estrogen cream is not used to increase systemic estrogen levels. It is used to restore the vulva’s blood flow and improves the thickness, stretchiness, and flexibility of its fragile tissues.

Some doctors believe that what truly matters is not the hormone content of the creams, but the physical barrier between the vulva and outside irritants that the creams provide. This does not seem to be true as many women who use different types of creams (not only hormonal) can definitely feel the difference in irritation level and see thickening of their skin while specifically using estrogen creams for vulvar pain.

#5: Types of Estrogen Cream for Vulvodynia Treatment

There are two main pre-made vaginal creams available in the US that you can use for pain relief for vulvodynia:

1

Estrace (estradiol vaginal cream 0.01%)

Estrace contains solely plant-derived estradiol, which is chemically similar to the estrogen hormone made by your body before menopause.
2

Premarin vaginal cream (conjugated estrogen 0.625 mg/g)

Premarin, on the other hand, contains a conjugated estrogen (a mixture of several types of estrogens). Estrogens are extracted from pregnant mares’ urine.

Another available option is a custom compounding vaginal cream, made by a pharmacist based on the doctor’s orders. In these kinds of vaginal creams, the dosage of hormones varies, as they are designed to suit an individual patient’s specific needs based on blood, urine or saliva hormone tests.

#6: Estrogen Cream Dosage

Vaginal creams for vulvodynia treatment are usually prescribed to be applied topically to the vulva (outside the vagina).

The goal of hormonal topical therapy is to keep the hormone dosage to a minimum, to limit side effects, while achieving pain relief qualities.

Creams might be used daily or several times a week. The exact dosing schedule might vary based on your doctor’s recommendations and the type of product used. Especially if you are prescribed a custom compounded cream.

Pre-made creams are usually recommended to administer:

1

Estrace

From 0.5- 1.0 g (amount the size of a jellybean) to the vulva two to three times a week; to a maximum of 2.0-4.0 g applied daily for one or two weeks.
2

Premarin

From 0.5-2.0 g applied daily for several weeks.

After the recommended period of time, creams should be gradually tapered off.

Sometimes you need to wait even up to 6 weeks to notice benefits.

#7: Best Practices for Estrogen Cream Uses

1

Sex Protection

Don’t use latex condoms, diaphragms, or cervical caps for up to 72 hours after applying estrogen vaginal creams. Some estrogen creams can contain oils that can weaken latex (rubber) and cause condoms to break or leak, or cervical caps or diaphragms to wear out sooner.
2

Intercourse

Avoid exposing your male sexual partner to your vaginal estrogen cream and don’t use it as a lubricant, as he can absorb the medicine through his penis if it comes in contact with the medicine. Avoid having sexual intercourse right after using the medicine.
3

Eyes

Keep the medicine out of your eyes. In case of getting it inside, please wash your eyes with a large amount of tap water.
4

Underwear

Vaginal creams can dirty your underwear. Use a mini pad or sanitary napkin to protect your clothing.
5

Application

Wash your hands before and after applying the medicine.

#8: Estrogen Cream Side Effects

It is believed that external and precise use of estrogen cream for vulvodynia minimizes the absorption of estrogen by the entire body, which can lessen some side effects, although, women’s individual responses may differ.

However, long-term studies on the use of low-level estrogen creams do not exist. Therefore the exact risk of the drug is unknown.

Some side effects may go away during treatment as your body adjusts to the medicine. However, each body is different and individual responses may differ.

Some common side effects of estrogen

Common side effects which can affect you when you’re starting medication, your dose is increased rapidly or it is too high, like:

  • Digestive problems (nausea, vomiting, bloating, gas, stomach pain and cramps, diarrhea, constipation, heartburn)
  • Breast problems (enlargement, tenderness, pain, swelling, lumps, nipple discharge)
  • Eye problems (problems wearing contact lenses, bulging eyes, sudden, complete or partial loss of vision or double vision)
  • Freckles, and dark areas of the skin on the face (melasma)
  • Changes in menstrual periods (spotting or breakthrough bleeding, missed menstrual periods, dysmenorrhea)
  • Headaches
  • Fainting, lightheadedness or dizziness
  • Weight changes
  • Fluid retention
  • Swelling, redness, burning, irritation, or itching of the vagina and vulva (due to application)
  • Vaginal discharges
  • Hives, rash, or blisters
  • Dry mouth and excessive thirst
  • Hair loss or unwanted hair growth
  • Back pain
  • Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
  • Runny nose, cough, or flu-like symptoms
  • Difficulty falling asleep or staying asleep
  • Changes in sexual desire
  • Acne
  • Crushing chest pain or chest heaviness, sudden shortness of breath or difficulty breathing, wheezing, hoarseness
  • Difficulty thinking clearly or remembering
  • Muscle cramps
  • Loss of appetite
  • Fevers
  • Joint pain, stiffness, or swelling
  • Vaginitis, including vaginal candidiasis

Some serious side effects of estrogen

  • Thromboembolism
  • Strokes
  • Heart attacks and hypertension
  • Breast and endometrial changes including fibroid enlargement or cancer
  • Gallbladder disease
  • Pancreatitis
  • Liver problems including cholestatic jaundice or enlargement of hepatic hemangiomas
  • Exacerbation of epilepsy
  • Mood changes or depression
  • Anxiety and nervousness
  • Erythema multiforme
  • Pulmonary embolism
  • Asthma worsening
  • Speech problems

#9: Estrogen Cream Interactions

IMPORTANT: When you use estrogen cream for vulvodynia, it is very important to let your healthcare professional know if you are taking any other prescription and non-prescription medications, and illegal, recreational, herbal, nutritional, or dietary drugs. Taking certain drugs simultaneously with estrogen can worsen some side effects.

Among the drugs that may interact with estrogen are:

  • Alcohol and tobacco
  • Antiviral medications such as Dasabuvir, Ombitasvir, Paritaprevir, Boceprevir
  • Antiretroviral medications such as Ritonavir, Darunavir
  • Medications used to treat or prevent excessive blood loss such as Tranexamic Acid
  • Antiemetic medications such as Aprepitant, Fosaprepitant, Netupitant
  • Certain types of antidepressants such as Bupropion
  • Certain types of anticonvulsants such as Carbamazepine, Fosphenytoin, Oxcarbazepine, Phenytoin, Primidone, Topiramate,
  • Valproic Acid
  • Cancer treatment drugs like Ceritinib, Dabrafenib, Encorafenib, Enzalutamide, Mitotane
  • Steroid medications like Dexamethasone
  • Medications for Alzheimer’s disease such as Donepezil
  • Antifungal medications such as Itraconazole (Sporanox) and Ketoconazole (Nizoral) or Griseofulvin
  • Acne medications like Isotretinoin
  • Diabetes medications such as Lixisenatide
  • Sleep disorders medications such as Modafinil
  • Antibiotics such as Nafcillin, Rifabutin, Rifampin, Erythromycin (E.E.S, Erythrocin), Clarithromycin (Biaxin)
  • Certain types of fruit such as grapefruits
    • It can interact with estrogen
  • Herbal remedies such as St John’s Wort (Hypericum perforatum)
  • Medications for thyroid disease
  • Medications for lowering cholesterol level such as Lovastatin (Alticor, Altoprev, Mevacor)
  • Progesterin (another female hormone)
    • If you still have a uterus (meaning you haven’t undergone a hysterectomy) you will experience monthly vaginal bleeding that is similar to the menstrual period for as long as the medicine is taken

#10: Estrogen Cream Contraindications and Warnings

1. If you have a very sensitive vulva and vagina:

You may not be able to tolerate estrogen topical cream as you may experience irritation that feels like itching or a mild yeast infection.

Some doctors claim that this can be a sign of the skin healing – the same as the healing of scars.

2. If you are prone to vaginal yeast infections:

One underlying cause of yeast infections is a hormonal imbalance. Estrogen plays a role in the growth and survival of the yeast Candida, therefore using estrogen can worsen your vaginal yeast infections.

3. If you are pregnant (or planning to get pregnant):

Estrogen should not be taken during pregnancy. Estradiol can harm an unborn baby and cause birth defects.

Please inform your doctor if you become pregnant or might become pregnant while taking this medication.

4. If you are breastfeeding:

Estrogen passes into breast milk and may decrease the amount and quality of breast milk.

5. If you are older than 65 years old:

Elderly women may be exposed to greater risk of certain side effects during estrogen treatment, especially stroke, breast cancer, and memory problems.

7. If you receive cancer treatment:

Estrogen may worsen or interfere with your treatment for breast, bone and uterus cancer. Additionally, it also may increase the chance of you getting cancer of the ovary or uterus (womb).

8. Don’t use estrogen or use it cautiously if you suffer from the following medical problems:

  1. Thyroid problems (underactive thyroid)
  2. Liver and gallbladder problems
  3. Blood clotting problems and high blood pressure
  4. Heart problems
  5. Vision problems
  6. Endometriosis
  7. Headaches
  8. Asthma
  9. Epilepsy
  10. Kidney problems

#11: Estrogen Cream Discontinuation

During discontinuation of estrogen, you might experience abnormal bleeding or flow.

Additionally, after ceasing topical estrogen creams, your vulva might become less sensitive to its own hormone due to increased exposure to it, which is called the rebound effect.

Conclusion

In this post, you can find general information about  low-dose topical estrogen cream for vulvodynia:

  1. What estrogen is and why it is important for vulvar health and ultimately vulvodynia
  2. Which estrogen vaginal creams are used for vulvodynia treatment
  3. Estrogen vaginal creams initial dosage and general uses recommendations
  4. What types of side effects you might experience while using estrogen cream, including withdrawal symptoms
  5. Possible interactions, contraindications, and warnings

Please don’t feel discouraged if your pain will come back after the discontinuation of estrogen creams. Or if you feel little to no relief while taking this medication.

Please remember that hormonal treatment is definitely not the only solution available for vulvodynia. There are still other medical and natural remedies that you can explore.

Did you find this post helpful? What other types of information would you like me to share with you?

Have you ever used estrogen cream? If yes, did it help your symptoms?

Share with me all of your thoughts, experiences, and questions in the comments below! You can also ask me anything directly on FB.

Disclaimer

My goal is to provide you with the most relevant and current information that is factually correct, comprehensive and up-to-date.

However, the drug information provided herein is subject to changes and is not intended to cover all possible:

  • Uses
  • Dosage indications and best practices for usage
  • Side effects
  • Drug interactions
  • Contraindications and warnings
  • Drug withdrawal symptoms

Additionally, each person is different and may respond differently to the drug.

Please also bear in mind, that this article should not be used as a substitute for the knowledge and expertise of a doctor or other licensed healthcare professionals. Please, before taking any medication, consult with a health provider who knows your medical history.

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Because life’s too short. And you deserve to be healthy + happy.



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