Estriol Cream is a Hormone Replacement Therapy (HRT). It contains the female hormone estriol (an estrogen). During menopause Estriol is used in vagina which is slowly released and absorbed into the surrounding area and into the bloodstream.

Estriol induces the normalization of the vaginal epithelium and thus helps to restore the normal microflora and the physiological pH in the vagina. As a result, it increases the resistance of the vaginal epithelial cells to infection and inflammation. In comparison to other estrogens, estriol is short acting. In the years just before and after the menopause (which can be natural or surgically induced) estriol can be used in the treatment of symptoms and complaints related to estrogen deficiency. Estriol is particularly used in the treatment of urogenital symptoms.

Estriol cream is indicated for the defficiency of estrogen. During menopause, the amount of estrogens produced by a woman's body gradually drops. Shortage of estrogens causes the vaginal wall to become thin and dry which leads to painful sexual intercourse. Estriol cream is used to relieve painful sexual intercourse. This is used in postmenopausal women with at least 12 months since their last natural period. If the ovaries are removed surgically (ovariectomy) before menopause, the decrease in estrogen production occurs very abruptly.

Estriol cream should be used as per physician's advice. Each dose of cream contains 0.5 mg estriol.

• For vulvo-vaginal complaints associated with menopause: Initially one dose of cream per day for 3 weeks. Later you may only need one dose of cream twice a week.
• Before surgery: One dose of cream daily 2 weeks before the operation. When having a Pap smear your doctor may recommend a daily application of cream for 7 days.

Administration

How to apply the cream:

• Remove cap from the tube, invert it, and use the sharp point to open the tube.
• Pull the plunger up to the ring. Now attach it to the opening of the tube.
• Squeeze the tube slowly to fill the applicator to the ring-mark (where the plunger stops).
• Remove the tube.
• To apply the cream, lie down; insert the applicator deep into the vagina.
• Slowly push the plunger all the way in until the applicator is empty
• After use, pull the plunger out of the barrel beyond the point of resistance and wash both parts in warm, soapy water. Do not use detergents. Rinse well and dry afterwards. Do not put the applicator in hot or boiling water.
• The applicator can be re-assembled by fully inserting the plunger into the barrel beyond the point where resistance is felt.
• Discard the applicator once the tube is empty. Take Estriol cream before taking rest or going to sleep.If you forget a dose, use it as soon as you remember. But if you remember your missed dose at the time of your next dose, do not use an extra dose. Do not use a double dose to make up for the missed dose. This may increase the chance of you getting an unwanted side effect.

Do not use Estriol cream if:

• You have or have ever had breast cancer, or if you are suspected of having it, ovarian cancer, heart attack, stroke, angina, liver disease , thrombosis, pulmonary embolism, vaginal cancer.
• You are pregnant or think you may be pregnant
• You have any unexplained vaginal bleeding, blood clotting disorder, endometrial hyperplasia, porphyria, and various kind of allergic reaction.
• Jaundice, migraine pain, high blood pressure & breathing problem
• You have had an allergic reaction to estriol, or any of the other ingredients of estriol

• Local irritation or itching of vagina, Swelling and increased tenderness of the breasts, Increased vaginal discharge, Nausea, Fluid retention in the tissues, usually marked by swollen ankles or feet.
• In most patients these side effects will disappear after the first weeks of treatment. Tell your doctor if vaginal bleeding occurs or if any side effect becomes troublesome or persists.
• Other side effects which may occur with HRT are benign and malignant hormone-dependent tumors such as endometrial cancer, heart attack and stroke, gall bladder disease, skin problems such as rashes, discoloration or red patches on the skin, various skin diseases with blisters and nodules or bleeding into the skin, venous thromboembolism or deep leg or pelvic venous thrombosis and pulmonary embolism (see Before you use Estriol Cream). Using HRT for several years slightly increases the risk of breast cancer.

Patients should keep under doctor’s observation for any Hormone Replacement Therapy (HRT). Same role is applicable for the application of Estriol cream. Doctor will give continuous advice regarding risks & benefts of the drug. But in case of jaundice, sudden high blood pressure, migraine, severe headache or pregnancy, the use of Estriol cream will be stopped immediately. Children’s are not allowed to use Estriol cream.

Pregnancy & Lactation

This medicine is contraindicated during pregnancy & lactation.