Q. My doctor recently prescribed Premarin Vaginal Cream. It has improved my life dramatically, reducing dryness and easing other symptoms of menopause. Are there any negative effects? Is it absorbed into my body?
A. Premarin Vaginal Cream contains conjugated estrogens just like Premarin pills. It has been approved by the FDA to correct vaginal dryness that leads to painful intercourse.
Over three decades ago there was evidence that vaginal estrogen cream (Premarin) could be absorbed rapidly and efficiently into the bloodstream (JAMA, Dec. 14, 1979). More recent studies have confirmed that estrogen in vaginal creams or tablets (Vagifem) is readily absorbed into the body (Annals of Oncology, April 2006; Menopause, Jan., 2009). There are concerns that vaginal exposure to estrogen might increase the risk of uterine or breast cancer in susceptible women.
Please discuss the benefits and risks with your physician. According to The Medical Letter on Drugs and Therapeutics, the long-term safety of vaginal estrogen creams remains unclear (Feb. 23, 2009).
The Estring also provides estrogen to the vaginal area to combat vaginal dryness but the dose is lower.
You can find out more about this and other ways to manage vaginal dryness in our Guide to Menopause. Many women find that lubricating with an edible oil such as almond, coconut or olive oil, is helpful. We are not aware of side effects so long as the woman is not allergic to the oil.
Others prefer water-based lubricants such as Sylk, containing a kiwi vine extract, especially for lubrication during sexual relations.
The FDA has approved a prescription medication, ospemifene (Osphena), to treat this problem. Rather than a vaginal cream or tablet, it is a pill to be taken by mouth. Although ospemifene is not estrogen, it does carry some of the same dangers. The manufacturer warns that there is a possibility that Osphena might increase the risk for endometrial cancer (cancer of the lining of the uterus) or strokes and blood clots deep within the veins. It recommends that women with breast cancer or liver impairment not take Osphena.