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Does Estrace Vaginal Cream Work Better Than Vagifem?
Question: Why does my doctor worry more about Estrace vaginal cream getting into the bloodstream more than Vagifem? I was using Vagifem at twice a week (10 mcg) for about 7 years and within the last year I guess it just wasn't working as well. Lots of pelvic pain during intercourse, more bladder issues, etc. I just switched to Estrace cream only twice a week at 0.5 gram. Upon reading the package insert, it appears they are the same medication (estradiol). I realize the dose is higher, but no one recommends using more Vagifem. Why do they seem to work differently on me? I am feeling much better after only a week.
Brief Answer:
The estrace in those doses is probably safe...
Detailed Answer:
Thank you for the question. Here are my thoughts in a list format:
1. Vagifem used to come in a 20mcg tablet but the company discontinued these and we now have only the 10mcg tablets
2. I agree, it does not work as well and I have prescribed estrace cream more often for patients
3. The advantage of the vagifem is that there was virtually no absorption of estrogen into your blood stream
4. Yes, there is a small amount of estrogen absorption with the cream
5. The dose and regimen that you are on is very low and probably very safe
6. If there is the slightest increased risk of breast cancer (which probably would not be statistically significant) then it might be outweighed by the significant improvement in quality of life.
7. You are going to get mammogram every year to screen for breast cancer
So, if you were my patient I would state that we were going to find the lowest possible dosing and regimen that achieved your goals (decreasing pain with intercourse, decreasing urinary leakage, decreasing risk of recurrent vaginal infections, etc.). Maybe you only need this once a week? Or maybe you can even lower the dose further and continue twice per week.
I do not think what you are doing is harmful, but consider getting a second opinion with an OB/GYN.
Great question and I am happy to help.
Dr. Tim
The estrace in those doses is probably safe...
Detailed Answer:
Thank you for the question. Here are my thoughts in a list format:
1. Vagifem used to come in a 20mcg tablet but the company discontinued these and we now have only the 10mcg tablets
2. I agree, it does not work as well and I have prescribed estrace cream more often for patients
3. The advantage of the vagifem is that there was virtually no absorption of estrogen into your blood stream
4. Yes, there is a small amount of estrogen absorption with the cream
5. The dose and regimen that you are on is very low and probably very safe
6. If there is the slightest increased risk of breast cancer (which probably would not be statistically significant) then it might be outweighed by the significant improvement in quality of life.
7. You are going to get mammogram every year to screen for breast cancer
So, if you were my patient I would state that we were going to find the lowest possible dosing and regimen that achieved your goals (decreasing pain with intercourse, decreasing urinary leakage, decreasing risk of recurrent vaginal infections, etc.). Maybe you only need this once a week? Or maybe you can even lower the dose further and continue twice per week.
I do not think what you are doing is harmful, but consider getting a second opinion with an OB/GYN.
Great question and I am happy to help.
Dr. Tim
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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