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Incontinence - urinary, in women - Management
What dose of intravaginal oestrogen should I prescribe?
- Topical oestrogens should be used in the lowest effective amount to minimize systemic absorption.
- Review at least annually to re-assess the need for continued treatment and to monitor for symptoms of endometrial hyperplasia or carcinoma in women with a uterus. For further information, see Adverse effects.
- Long term treatment may be required as symptoms can recur on cessation of therapy.
- For the treatment of atrophic vaginitis in post-menopausal women, licensed doses for intravaginal oestrogen preparations are:
- Intravaginal cream:
- Ovestin® (estriol 0.1%): insert one applicatorful daily for 2–3 weeks, reducing to twice a week.
- Pessaries/vaginal tablets:
- Ortho-Gynest® pessaries (estriol 500 micrograms): insert 1 pessary daily (preferably in the evening) until improvement occurs, reducing to a maintenance dose of one pessary twice a week.
- Vagifem® vaginal tablets (estradiol 25 micrograms): insert one vaginal tablet daily for 2 weeks then reduce to one vaginal tablet twice a week.
- Vaginal ring:
- Estring® (releasing approximately estradiol 7.5 micrograms over 24 hours): insert the ring into the upper third of the vagina. The ring is then worn continuously for 3 months before replacing with a new ring.
- For information on the duration of treatment, see Management of urgency incontinence symptoms/ overactive bladder.
[BNF 57, 2009]
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