How and when to use vaginal oestrogen - Brand names: Vagifem, Gina, Ovestin, Vagirux

Dosage

Your dose of vaginal oestrogen depends on the type of medicine you're using:

• vaginal tablets (Gina, Vagifem, Vagirux) – insert 1 tablet a day for 2 weeks, then 1 tablet twice a week
• a vaginal ring (Estring) – insert 1 vaginal ring into the vagina for 3 months
• vaginal gel (Blissel) – insert 1 dose of gel a day for 3 weeks, then 1 dose twice a week
• vaginal pessaries (Imvaggis) – insert 1 pessary a day for 3 weeks, then 1 pessary twice a week
• vaginal cream (Ovestin) – insert 1 dose of cream a day for up to 4 weeks, then you can reduce your dose gradually depending on symptoms

How to use vaginal oestrogen

Using vaginal oestrogen tablets

1. Wash your hands and get yourself into a comfortable position. You can either stand up or lie down.
2. Open the pack and remove the applicator. The tablet should already be inside it.
3. Hold the applicator so one finger can press the applicator plunger.
4. Insert the applicator carefully into your vagina. You can do this either standing up or lying down. Try to insert about half of the applicator and only go as far as you're comfortable with.
5. Press the applicator plunger until you feel it click. This lets you know that the tablet has been released. The tablet will then attach itself to your vaginal wall.
6. Gently remove the applicator and throw it away.

Using vaginal gel

Your gel will come in a tube. It will also come with a plunger and a small, empty tube (cannula) to help you insert the gel.

1. Wash your hands and remove the tube cap. If it's the first time you're using the tube, pierce the seal on the neck of the tube but do not use it if the seal is broken.
2. Insert the plunger into the cannula and screw the end of the cannula onto the neck of the tube.
3. Squeeze the gel into the applicator until it reaches the filling mark. The plunger will stop at that mark.
4. Unscrew the cannula from the tube and replace the cap on the tube.
5. Get into a comfortable position, either standing or lying down, and insert the end of the applicator into your vagina.
6. Push the plunger all the way down.
7. Gently remove the applicator. Throw the cannula away and rinse the plunger with warm and clean water so you can use it again.

Using vaginal pessaries

1. Wash your hands and get yourself into a comfortable position, either standing up or lying down.
2. Remove the pessary from its foil pack.
3. Standing up or lying down, gently insert the pessary as far into your vagina as you can.
4. Wash your hands. If you're using Vagirux, you can use the applicator again. If you're using Vagifem, throw the applicator away.

Using vaginal cream

1. Wash your hands and remove the cap from the tube. If it's the first time you're using the tube, pierce the seal on the neck of the tube but do not use it if the seal is broken.
2. Screw the end of the applicator onto the tube.
3. Squeeze the cream into the applicator to the red ring mark. The plunger will automatically stop at that mark.
4. Get into a comfortable position, either standing up or lying down. Gently insert the applicator into your vagina and push the plunger as far as it will go.
5. Remove the applicator and take the plunger out of it. Wash the applicator and plunger in hot, soapy water so you can use it again.

Using a vaginal ring

1. Wash your hands then find a position you feel comfortable in, either standing up or lying down.
2. With one hand, squeeze the ring into an oval shape and gently push it into your vagina. Do this in the direction of upwards, backwards and towards the small of your back.
3. Wash your hands when you've finished.

You can use your vaginal ring for up to 3 months. After that, you'll need to remove it and replace it with a new one.

If your ring falls out, rinse it in lukewarm water and insert it back into your vagina.

If you're going to have sex, you can either leave the ring in place, or remove it if you find it uncomfortable.

You may notice that the ring shifts when you have a poo. If this happens, you can easily push the ring back into position with your finger. If you're constipated or know you're going to find it difficult to poo, it's best to remove the ring completely and then put it back afterwards.

How long to use it for

You'll usually be recommended to take HRT for between 2 and 5 years to relieve symptoms but you may need to take it for longer, and there is no set limit on how long you can take it.

It's recommended that you speak to your doctor at least once a year, to check whether the benefits of using vaginal oestrogen still outweigh the risks.

If you forget to use it

No matter what form of vaginal oestrogen you use, never insert 2 doses at the same time. Never insert an extra dose to make up for a forgotten one.

If a doctor has advised you to use vaginal oestrogen regularly and you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to use your medicine.

Vaginal tablets and cream

Insert your missed tablet or dose of cream as soon as you remember.

Pessaries

If you forget to insert your pessary during your 3 weeks of daily treatment, skip the missed dose then insert your next pessary at the usual time.

If you forget to insert one of your 2 pessaries during your 1 week of treatment, insert the forgotten dose as soon as possible.

Gel

Insert your missed dose of gel as soon as you remember, unless it's been over 12 hours since your last dose. In this case, wait until the next one.

If you insert too much

Inserting an extra dose of vaginal oestrogen is unlikely to harm you. If you're worried, talk to a doctor or pharmacist for advice.