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How Safe Is Vaginal Estrogen Cream?

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Q. I have a lengthy history of urinary tract infections (UTIs) that occur approximately every five months. I have seen a few urologists and had multiple tests, which have all come out normal.

Both my current urologist and my gynecologist are pressuring me to use Premarin vaginal cream to reduce UTIs. Due to the fact that my mother, her sister and my sister have all had breast cancer, I have refused. Last month at my annual exam my gynecologist insisted that the vaginal cream is not absorbed into the blood and will not promote breast cancer. When I mentioned the warnings I've seen in pamphlets and on the Internet, my doctor got very angry and said the warnings are for the "old HRT" and do not pertain to the vaginal cream.

I filled the prescription for Premarin cream but found in the literature insert that the top side effect listed is breast cancer. I am terribly confused and do not know which path is the correct one.

I have always been told with my family history to avoid all estrogen, even soy products, but I don't want to be foolish by damaging my health with continual UTIs.

A. 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 breast cancer in susceptible women.

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42 Comments

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I used to be plagued by UTI's. I had every test my urologist could think of with no answers. I'm allergic to chlorine and it never occurred to me that might be the cause of the UTI's until I moved. My new home was on septic, the city water was not heavily chlorinated, and we have a substantial filter for our water. I quit getting sick after we moved. You might look at your water report and switch to purified water to see if that helps.

Regarding UTI's. It's very important to wash your hands frequently. Also, your partner should wash his or her hands frequently, especially before sexual contact.
I have a client who suffered from frequent UTI's. Although I'm not a doctor, I'm an LMT and I volunteer in a hospital and know how absolutely imperative frequent hand washing is... I advised my client regarding this and she has not had one bout of infection since. Coincidence? Maybe, but it can't hurt to try.

Both my wife and I read your col. in the Houston Chronicle. The Jan 6 art. on Vaginal Cream was informative, however your statement that "More recent studies have confirmed that ESTROGEN (emphasis is mine) in ---- 2009)." Estrogen is the natural form which the body produces. I believe you should have used the name of the synthetic form that is used in the cream sold in pharmacies. I believe that the natural form is completely safe and I wish newspaper accounts would report more accurately and identify the actual substance used rather than giving natural hormones a bad name.

PEOPLE'S PHARMACY RESPONSE: THE TERM FOR THE INGREDIENTS IN PREMARIN, BOTH ORAL AND TOPICAL, IS CONJUGATED EQUINE ESTROGENS.

Be sure you are wiping from the front to the back. Wiping back to front can drag feces to the opening of the urinary opening and can cause infections.

This is why I don't like doctors. Wonder if this person's doctor has looked into other issues that can be confused with a UTI? Such as Interstitial cystitis. I have a friend with the same issues and all the doctors wanted to do was throw antibiotics at her even though she tested negative for a UTI time and time again. After her frustration with them, she finally found a doctor that listened to her and he discovered her issue was Interstitial cystitis.

My wife had trouble with UTI's for years ( normally after sexual relations ). Her UTI would come on fast and was very painful and caused a few trips to the emergency room. In my search for an alternative to the standard antibiotic treatment I found that "On Tract Plus Capsules by Kordial Nutrients" prevented the infection from occurring ( one capsule with a half glass of water after sexual relations ). If my wife would forget to take the capsule and an UTI started to develop one capsule W/ water 2x day for a couple days would knock it out.

This in my opinion is such a safe and simple solution I do not understand why the medical profession does not use it as a standard UTI treatment. I do not remember how I found out about "On Tract Plus" but it definitely works for my wife and not side affects. The product contains D-mannose.

HRT can be inappropriate for some people. One way of determining one part of the risk is to measure how the estrogen is cleared from the bloodstream by the liver. This is important because one clearance pathway is more caustic on the body (16OHE) and the other is not (2OHE). This is known as the estrogen metabolite index and can be measured in a first morning urine from Metametrix Laboratory among others.

There name for the test is Estronex. Lifestyle changes including increased consumption of polyphenol-containing foods, flax seeds, cruciferous vegetables, adequate calcium and protein, decreased caffeine and eliminate smoking. DIM (diindolylmethane) can help this ratio.

Get another doctor, this one appears to be uninformed and insensitive

For UTI's I've found a course of 2 or 3 days of cranberry extract pills (3x a day) ends the problem. And it is reduced by drinking a small amount of cranberry juice every day.

Your doctor became angry with you when you had valid concerns? Find a new doctor who will listen to you.

Have you be checked for interstitial cystitis? My UTI's came every few months and I was finally diagnosed with IC. The urologist checked me for it after I absolutely refused to take any more antibiotics. There is a very accurate test for IC now. Although I first took medication, I now control it with diet. A simple solution to a very painful and debilitating illness. I hope this is helpful.

I think the key is that your family history puts you into a more vulnerable place in "trying" anything with estrogen/progesterone affects. This process may work well for others. I had a series of doctors recommending the same product, but hated using it, and still had the uti's UNTIL I found an explanation that some women produce far too much of the wrong bacteria's on a regular basis, maybe from having taken too much anti-biotics at one time, maybe something else, but, getting serious about taking a high quality, pro-biotic on a daily basis, along with a daily cranberry extract product has completely solved my problem.

I am grateful and amazed that this dual protocol has kept me UTI free for almost 3 years now. If you are starting out, I would take a dose of probiotic in the morning and again the evening for the first week, to give you a boost, then level to the recommended daily amount. My physician assured me I couldn't take too much pro-biotic, and if I did I'd get some looser stools to warn me to cut back, but I never had this experience. She is now suggesting other patients with chronic UTI problems, try this, as many women do not want to do the vaginal creams.

Cranberry, cranberry, cranberry! Every morning, take a cranberry tablet-good quality (for instance, I take 300mg of Eclectic Institute Cranberry- but any reliable source should do & perhaps you need a higher daily dose). When you feel the urinary infection coming on, increase the dose to multiple times a day. I've been doing it for approx 10 years- with fantastic results. No more infections.


My mother has battled UTI's for seven years. She has tried everything. It was to the point where she was having them monthly and the doctor told her the only hope was to have her catheterized.

This didn't go over well. My mom is an active woman who is otherwise healthy, so I started doing some research and came across numerous recommendations for a product called D-mannose. D-mannose is the highly concentrated form of the sugar that is in cranberries and it binds to e-coli to clean it out of your bladder. Since it is so concentrated it works more effectively than just cranberry juice or pills.

Figuring we had nothing to lose, my mom started using it about 9 months ago, and she's has only had one infection since soon after she started taking it - figured it was clearing the e-coli out. She hasn't had an infection in about 6 months. Her urologist was familiar with D-mannose, but he are so impressed with the results he's told her to stay on it.

What I like about it is that you can adjust the dose, and take more if you feel like an infection is coming on, and then take less when you feel your symptoms abating. I don't normally endorse products, but my mother was becoming so depressed and withdrawn and now she's happy again. You can order it off the internet or find it in a health food store. It might be worth trying. Can't hurt.

I too had a long history of yeast infections. My GYN had a diabetes workup done and sure enough, I was borderline diabetic. Through diet I keep it under control, but the best part is no more yeast infections (unless I eat poorly!) Also Acidophilus helps to keep my good bacteria counts up and also helps keep yeast infections away.

All I know is that I suddenly started getting bladder infections after I began the Omega 3 fish oil. The Dr. didn't believe that could be the cause and prescribed Pure stuff and that was the same - 3 times on oil and 3 bladder infections. I said I'll not take it and if I have another bladder infection, I will go back on the oil and see a urologist. That was a year ago Sept. Not one - it's weird but our bodies can be weird so if you are on the oil, try going off and see if it helps.

Sounds like a new gynecologist would be in order too.

After many years of enduring numerous UTIs, my Gynecologist asked me a surprisingly simple question. "Do you take regular tub baths or showers"? My answer was tub baths. His reply was "stop taking tub baths and start taking showers". Many of us (particular women) have a very narrow UT, and when taking a tub bath we are literally sitting in a pool of germs (think about it, and it will makes sense). Sitting in bath water allows those germs to infiltrate into the UT, thus causing UTI. I have not taken a tub bath in over 25 years, and have not had even the slightest UTI.

The idea is to stop sitting in a tub of germs,versus a shower where you have continuous clean water washing those germs down the drain and not harboring when they do not belong. Such a simple solution to a painful situation. If you find you MUST take a tub bath, be sure you clean and sanitize the entire tub before use.

My gyn gave me Estrace vaginal cream, but told me to use it externally only. So far, so good.

I suffered for years from recurring bladder infections after getting married. I even was catheterized to be sure my bladder was emptying all the way (which triggered another infection!).

One day my sister-in-law told me that her son's doctor had advised him to start using Dial soap after he developed a staph infection on the skin underneath his football shoulder pads. The light bulb went off in my head--my infections began after I switched from Dial to another product which made me feel "zestfully clean". I went back to good ole Dial and that solved my problem.

Diet seems to play a role in UTI's. I am 71 and only had 2 bladder inf. ever and each
time it was after eating ice cream several days in a row. I am very sensitive to dairy
and the extreme cold ice cream does it to me. I can eat yogurt and nothing happens. Seems like some diet sleuthing is in order and lots of probiotics, especially after the antibiotics. Watch those diet drinks, maybe there's a clue.

Frequent UTI's are always a problem for me. I am now taking Cystex ( a concentrated cranberry juice formula) and so far, a a tablespoon daily seems to work. Also using the premarian cream once weekly.

Everyone in my family is allergic to Dial soap, it causes itching and rashes. We make sure to pack an alternate soap for hospital stays because Dial is so frequently stocked in hospitals.

I read today's article about the women with the urinary tract infections. My step mom had that problem for years. Nothing a doctor advised worked, creams, lotions, pills, etc. She bumped into somebody else with the same exact problem. She recommended eliminating ALL caffeine from her diet, my step mother drank sweet tea for years and the occasional coke.

She went to decaff tea and coke, it's been two years and has not had a urinary tract infection since. Please recommend this as a solution to try. It's something simple, and it's something the doctors' never recommend.
~Kali

I have the same problem. Mine went away for 9 years after I had an urethral dilation. They just started to come back. My urogyno gave me a prescription for estrogen cream I am 32. 2 kids. Family history of BC. He told me that the amount I use externally, a dab on my finger, was low risk and the warnings didn't apply so much.

The leaflet with the meds showed a full applicator applied up and in whereas mine is a dab down at the openings. I have used it 3 times it's still to soon to tell any side effects.

I chose to do this as I am allergic to PNC from birth so they would give me sulfa based drugs to fight off UTI's. My first UTI was at 16 by 21 I had taken sulfa my body rejects it and I have severe allergic reactions. You don't want that trust me. So I have to take levaquin for everything. I feel the tendinitis kick in now with the first dose. It hurts when I straighten my limbs out as there is no elasticity when on those.

I am trying the cream for these reasons but if I get one more within the year I will be asking for the dilation again. Good luck to you. I have been through all the tests too and checked out fine.

Our Yankee reader should try any of the cranberry solutions mentioned by several people. Also the probiotics. I'm not a medical person but taking an estrogen cream seems like a weird solution for an infection!

same here, I got bladder infection after three or four days after I started to take Omega 3.

It is so weird... One day I took Omega 3 purposely to see if that is really causing the pain when I urinate. I started to have bladder infection symptoms again after three days. (No sexual intercourse for one month). When I have bladder infection from sexual intercourse it was treated very easily with small dose of antibiotics, but in the case of the pain I got from Omega 3, it persisted longer and I had to take several kinds of antibiotics to make myself feel better.

I was prescribed Estrace Cream for vaginal atrophy. I was told to inject into the vagina. So far so good, until I went to fill the RX, it was not covered by my insurance and would cost me over $100. to purchase. I can't afford to pay this for one prescription.

So I asked for the estrogen patch instead, it would cost $5.00 per month. My Doctor refused because I still have my uterus. She said it was dangerous for me to use the estrogen patch. How can this be? Cream applied directly to the area O.K... A patch with the same ingredients dangerous.

I went to a gynecology for a pap test and it was very painful. I have not had sex in ten years because my husband has erectile dysfunction and not able to so she told me that with menopause and no sex that the lining gets smaller I told her I was having itching, hurting inside. She said that's what cause it should I be on some kind of vaginal cream because it really hurt severely thank you.

People's Pharmacy response: Some sort of vaginal lubricant will probably make you more comfortable. Did the doctor prescribe something?

I had severe menopause symptoms including constant urinary and vaginal infections. My gyn started me on Estrace cream. Just a tiny amount is all you need. After 3 months, the hot flashes subsided, the constipation stopped, I was sleeping peacefully, the anxiety and mood swings stopped, my hair started growing again and my skin was no longer ashy and dry. Oh yes, and the infections were gone! Estrace cream is highly effective and very safe. I urge you to at least give it a try. It takes a while for symptoms to improve but you'll be glad you did.

I am 56 and had an abnormal pap smear reading. My doctor wants me to estrogen cream inserted for 14 days then come back in on the 15 day and have another smear done. I have used the cream for three days and had terrible side effects. Does anyone know why the usage of the estrogen cream is all about?

Estrogen cream (Preferably Premarin brand which is natural and contains conjugated estrogens) inserted into uterus and applied outside on the labia is for dry, atrophied uterus and bladder which are really attached to one another (look at a rendering on a medical site) - also the interior skin is dry and gets very thin post-menopausal. This atrophying and dryness cause itching and burning of uterus-bladder and vaginal walls, as well as simulating a bladder infection, I say simulating because a urine test will come back showing no infection. One's own urine too irritates this dry skin.

It is a big problem in older women (I am 74 and have been taking .3 Premarin tablets since age 52 but even that was not enough for what I just described. I keep the area scrupulously clean, especially through nightly showers before sleep and cream application - I also use the D Mannose powder in purified water (Brita) and cranberry concentrate (not juice with sugar from the grocery store).

You have to try different amounts of everything until a balance is found which makes you feel good and eliminates the problem. You have to weigh the possible adverse effects that are listed against your actual problem to decide about estrogen.

Hi, I have been having a white discharge with burning sensation since a year.. so many tests done but normal. I am depressed don't know what to do. I am 34 years old. Have two kids. Took so many medicines but no relief... please help

I use Estrace vaginal cream three times a week, but put a small amount on my fingertip instead of using the larger pump. It's a phytoestrogen rather than a mare's urine product. Are there any bioidentical creams available?

I was bouncing back and forth between my gyne and urologist. I would get a UTI, get on antibiotics, then develop a yeast infection. This went on for 8 months and drove me crazy between the pain and itching and my tissue cracking from all the meds. I asked both doctors if these problems could have been caused by Synthroid, they said no. I had been diagnosed with hypothyroidism. That doctor put me on 500 mcg. of Synthroid and wanted me to have my thyroid removed by none other than her husband. She had an office full of people with their necks wrapped from surgery.

I've since changed from Synthroid and have gone onto Armour Thyroid at a gram a day. My family doc was able to balance my thyroid better than the endocrinologists without surgery. Also, the urologist said he wanted to dilate my urethra to prevent infection. Needless to say, I never went back to him, since I did not want a problem with holding my urine too.

Always wear cotton panties, not nylon or synthetic. Use a gentle soap like Dove on your private parts. Have your doctor run blood work checking all your thyroid levels. If your thyroid is in balance, you might clear up your UTI and yeast infections like I did.

I have not had another UTI or yeast infection in over 20 years.

Good Luck.

To Barbara, when I fussed about the cost of Estrace, (Tier 3 on the Medicare formulary) my doctor gave me a prescription for a natural cream, Estradiol, that you have to take to a compounding pharmacy. I just called the local compounder and was delighted to find out that it was $30 cheaper than Estrace! As you said, Estrace is a phytoestrogen rather than Premarin which is a mare's urine product.

I was put on Premarin for vaginal atrophy. I was not given an amount, it just said an applicator full. I developed a very engorged vagina and began to experience very light period symptoms including discharge although post menopausal for 10 years. I became concerned and stopped use. I have used a product to hydrate that is over the counter for two weeks. I am gradually returning to normal and will watch for atrophy in the future. I wish that alternatives had been explored prior to this usage as the potential side effects are very concerning.

I was experiencing burning upon urination which could be misinterpreted as UTI as one symptom prior to medication. No actual UTI occurred.

I am post menopausal and have been plagued by recurrent UTIs for about 8 years. The only thing that really helps is D mannose powder, a good brand, use for maintenance or use 3-4 teasps. per day when infection is roaring.

Also, Azo cranberry, daily one, but not during the infection. The D mannose powder has cranberry in it, or fruit.

Also, Bioidentical estrodiol vaginally, from a compounded pharmacy or woman doctor who has sense and can
prescribe it, low dose, maybe 3-4 times per week at night, cause it's messy, in vagina, 05 mg.
Also use bioidentical progesterone cream (very important) about 24 days per month and off about 4-5.
must use progestin cream in natural form like this along with the natural estrogen.

This is the only thing that keeps my UTI down, maybe 1 time per yr, with the above regimen, cause I
also have atropic vaginitis, and a partially prolapsed bladder from 5 child deliveries, all common
in post menopause

I want to take a natural vaginal cream for dryness because I believe it will help my uti problem, among other things. My mother had breast cancer so I am afraid of taking anything hormonal.

What is a natural, hormone free cream to take? Are the biodenticals safe? Please help me with this. I am at my wit's end.
Thank you

I bought the D mannose with CranActin (Solaray brand) and have been taking it for two days and wanted to know if anyone had any luck with this brand? I don't know if I have a UTI (will get tested), but I am waiting for my culture to see if I have BV or yeast infection.

As an ex nurse why don't you listen to your gynaecologist? I was taken off hrt because of factor 5 leiden. Having had major surgery for vaginal prolapse repaired I continued with utis and discomfort after stopping hrt and Bering past menopause.

Thank goodness I was put on gynest 0.01%. No it is not absorbed as normal hrt is and there's a lot of rubbish printed about it on this site. Perhaps you should all listen to your medical advisers, all medications can be accused if causing something and without them our life span would be shorter. No I read side effects and generally ignore them seems to me if I took any notice they could cause anything from gum boils to warts.

I'm 57 on estradiol .5 day for the ten years had a complete hysterectomy but I'm really dry lately so doctor gave vaginal cream, but I put inside vagina, but it's not being absorbed it stays in and comes out when I use the toilet.

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