Q. My doctor prescribed Premarin Cream for vaginal dryness. He said I wouldn’t absorb enough to be a problem. The paper insert that comes with the drug makes me question its safety, however. Is it absorbed into my body?

A. Premarin Vaginal Cream is absorbed through the vagina into the blood stream. It should be given the same respect as oral medicine.

We find it fascinating that health professionals and patients tend to believe that pills are absorbed but “topical” treatments that are applied to skin or body cavities somehow stay put and do not get into the blood stream. Over 30 years ago an article in the journal JAMA (Dec. 14, 1979) reported that vaginal estrogen cream could be absorbed quickly and efficiently into the blood stream.

In 2006 an article in the journal Annals of Oncology (April issue) confirmed that vaginal estrogen tablets (Vagifem) or creams are effective ways to get estrogen into the body.

Research published in the journal Menopause (Jan.-Feb. 2009) noted the following:

“The present data using validated, accurate, and sensitive mass spectrometry assays of estrogens show that the Vagifem pill and Premarin cream, after 1 week of daily treatment, cause an approximately fivefold increase in serum estradiol in postmenopausal women, thus indicating that the effects are unlikely to be limited to the vagina and that systemic actions are expected after application of these intravaginal estrogen preparations.”

A study in the journal Fertlity and Sterility (Nov. 2010) compared estrogen levels in blood after seven days of oral treatment (0.3 mg conjugated estrogens) and then after seven days of vaginal cream (0.5 grams). The women in the study had “severe atrophic vaginitis.” In other words, they were suffering from vaginal tissues that were quite dry. Although estrogen was clearly absorbed from the vaginal cream, levels in the bloodstream were one-third lower than after oral doses.

This finding might be quite reassuring except for the fact that the atrophic vaginitis might have affected absorption. It would be interesting to see what the absorption levels might be after several months (or years) of treatment. Once the atrophic vaginal tissues have healed they may be more susceptible to estrogen absorption.

Other Options for Vaginal Dryness:

It is clear that estrogen can be absorbed into the blood stream whether it is taken orally or intra-vaginally. That means that the benefits and risks of estrogen should be roughly comparable, regardless of the route of administration.

Many women would like to know what they can do, besides taking estrogen, to deal with vaginal dryness. There are a number of other options that can be considered. Visitors to this website have shared their experiences with non-traditional approaches:

Coconut Oil

“I have been using coconut oil for vaginal dryness for quite some time and find it solves the problem. I use it whenever I feel an irritation occurring. It can be applied manually with the finger but this does not always get it to the irritated spot. I use a plastic plunger-type applicator that came with a vaginal lubricant I bought on line.

“The coconut oil comes in a jar and turns to a liguid if kept in a warm location, but turns solid if in a cool location – not necessarily in the fridge. If you have the plunger, all you need to do is be sure the oil is fairly solid and use a clean spoon to pack it in the plunger – no problem.” Vonnie


Olive Oil

“We have been using olive oil for lubrication for some time now and it is great. It is better than any off the shelve lube that we have tried and it lasts a long time unlike many of the other popular lubrications which tend to dry up after several minutes. The consistency is very close to the natural lubrication and as far as we know there are no side affects with using olive oil.” B


Alove Vera Gel

“My husband and I can’t use KY Jelly or any other brand of lubricant we have tried. They make me itch and burn.

“We have found, though, that the slimy gel that oozes from aloe leaf when you break off a piece is a very good lubricant. I hope this will add to your uses of aloe vera and help another couple.”


 

You will find a number of other stories for easing vaginal dryness using olive oil and coconut oil on this website. Aloe vera gel should be more compatible with latex-based contraceptive protection such as condoms and diaphragms, when that is a consideration. Oils destroy latex.

Another solution to assist with vaginal dryness includes hyaluronic acid.

Our Guide to Menopause offers additional suggestions.

Share your own story below.

 

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  1. nerdpocalypse
    md
    Reply

    I doubt atrophic vaginitis is going to affect absorption…because the absorption is so very very good to begin with!

    Seriously, there are some drugs where the topical is higher than the oral because it gets around the liver (and other digestion) metoclopramide is one, and I suspect estrogen/progesterone/etc to be another.

    If you seriously are concerned that these real drugs with real consequences will really do something overall when giving topically the same milligrams (or more) as in a pill?… you are very correct!

  2. KJ
    New Hampshire
    Reply

    I take Bio-Identical hormones it is applied as a topical cream; I wonder if there is less risk with this than there would be with synthetically made hormones?

    My doctor treats it as she would any hormone therapy making sure I do self breast exams, yearly mammographies, she also had me get a vaginal ultra sound. She is very cautious about the treatment and has never said they are any safer than the synthetics. I am just curious because there are websites that claim they are safer.

  3. ariel
    Reply

    please let me know how to take thyroid med at night..
    as in with food, without food how long before eating or after..
    at bedtime I am hoping I will not need to eat before taking this

    I too suffer from struggling to sleep and wake up tired. and over sleep

  4. ariel
    usa
    Reply

    ok coconut oil.. I like it BUT cannot find a condom that works with it????
    any suggestions.
    olive oil? what kind condom?
    I was told at a health food store to try sea buckthorn = omega 9
    or fish oil that contained omega 9 and they might help with vaginial dryness..
    if I cannot find a condom that is safe to use with coconut oil or olive oil .. I may try one of the Omega 9 suggestions. any comments or suggestions is greatly appreciated..
    my gyno seems to know nothing about condoms and lubs.

  5. Verna
    Reply

    I have lichen sclerosus and vaginal dryness. For 10 years I used estroil gel vaginally and it worked well for both. I did get breast cancer 3 years ago (triple negative). Now I have been using clobetasol prop. 2x a week and for the last 6 weeks I have been using purple emu oil and it seems to be getting better—- The doctors say not to use any type of estrogen ever again.
    I am hoping to cut back on the clobetasol if emu oil turns out to help. Coconut oil, vitamin e, plain emu oil, olive oil and hyaluronic acid did nothing for me.

  6. MFK
    Reply

    I would be interested to know where the estradiol vaginal ring is on the risk scale. Earlier studies seemed to indicate a low risk for systemic effects, perhaps because the dose is distributed over 90 days? There are post-menopausal women who use it to prevent cervical atrophy. Thanks for any information.

  7. J.L.S.
    Reply

    I had to stop using prescription topical estrogens as they caused breast changes. Then I was diagnosed with breast cancer and told not to ever use these products.
    I am dismayed that doctors prescribe topical estrogen vaginal creams to patients who have had breast cancer or a family history of breast cancer.
    Thank you for this excellent research review.

  8. JKC
    Reply

    It amazes me that they continue to say that topicals aren’t absorbed into the blood stream, but then they prescribe “patches” to get drugs into the bloodstream.

  9. Beth
    Reply

    I have used both the Premarin cream and tablets. I highly prefer the tablets and use them now once a week. 14 years ago u had breast cancer that was hormone positive. I had surgery, radiation and chemo followed by five years of estrogen blockers. My cancer doc was a man. I was 47 and not into menopause but my first chemo sent me there. My doc never told me about the affects of the estrogen blockers on all my orifices.
    Finally after thinking I had vaginal cancer my primary said it was an extremely dry vagina and I could take the cream. He said I should not worry that it was a small dose. He said if my hot flashes stopped or decreased significantly then he would worry but to take it as directed. I do use other lubricants as noted above and they help but the Premarin is needed. The hot flashes never decreased or have totally gone by the way. I still have issues with them and night sweats.
    The person who said you know your own body best is right :). Be aware and read all the information available. Talk to your dr yearly about the newest research. I really like the Peoples Pharmacy and recommend it often.

  10. PDH
    Reply

    My wife started taking premarin for menopause not long before she had a stroke 10-12 years ago. I recognized her condition and got her in the hospital very quickly, which probably saved her life. The doctors would never say there was a connection with the premarin, but we believe it was suspected. You might want to get several opinions on it.

  11. M.L.Wood
    Reply

    This information was extremely useful—a subject that isn’t widely discussed but needs to be addressed with women living so much longer.

  12. VS
    Reply

    I use Premarim cream to help with incontinece. Do you have any other suggestion besides Klegle exercises?

  13. Dma
    Reply

    My doctor (a lady) suggested that I use lard- the kind one uses to make pie- not butter flavored. I used it quite often throughout the day for about two to three years and now I don’t need it except on rare occasions. Life is good………

  14. Mrs M
    Reply

    My doctor at the hospital has given me Estriol (Ovestin)0.1% for incontinence, but after reading the leaflet I have decided no to use it.

  15. Anne
    Reply

    I find these articles so frustrating because NOTHING seems to be totally safe. I wonder if there was an extensive study on some of the “safe” alternatives they might also have issues. I tried a number of things before going back to Premarin cream and none of them worked for me. It wasn’t just a matter of having a good lubricant, intercourse was painful. I know there have been lots of studies on HRT and it’s probably a good thing doctors have cut back on prescribing it. And yet, I’ve known plenty of women who took it orally and had no bad consequences. As for me, I use the smallest dose possible three times a week along with a lubricant as needed and I’m very happy with the results.

  16. PT
    Reply

    I feel that this article is misleading. Women are put on local vaginal creams for other than vaginal dryness. Coconut or olive oil is no remedy for abnormal conditions of the vagina that result from extremely low estrogen.

  17. cpmt
    Reply

    MANY DOCTORS don’t know or don’t care of drugs side effects or how they affect the person. You are your best doctor, act in consequence and look for another more natural solution. I am tired of doctors telling me, “this drug has nothing to do or causes your new problems’ or ‘this drug doesn’t have these side effects’.

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