Several types of vaginal estrogen are now available and can be extremely helpful for treatment of the effects of menopausal estrogen deficiency on the vagina and bladder.

Concern about risks of treatment for one preparation, high strength vaginal estradiol cream, (Linoladiol, Linoladiol N, Linoladiol Estradiol, Estradiol Wolff, and Montadiol) has led to a restriction on duration of use. The European Medicines Agency (EMA) has advised a limitation on use of a single treatment period of 4 weeks for estradiol creams providing 100mcg/g (0.01%).

This ruling has been challenged by the North American Menopause Society stating that the recommendation “is not evidence based”.

Meanwhile, it is concerning that some practitioners may interpret this ruling as being applicable to other types of vaginal estrogen. The type concerned is not used in the UK, and there is no concern about the use of low dose vaginal estrogen preparations prescribed in the UK. Vaginal and bladder symptoms of estrogen deficiency (Genitourinary Syndrome of Menopause, Urogenital atrophy, Vaginal atrophy) are extremely common, even in women taking HRT, and cause significant distress. Low dose vaginal estrogen preparations should be initiated as usual practice, and it is recommended that treatment be continued long term.