Topical oestrogen (low-potency)

Estriol

Brand names: Ovestin, Blissel

Adult dose

Dose: 0.1% cream or 0.05mg gel: 1 application intravaginal OD for 2–3 weeks then twice weekly

Route: Vaginal

Frequency: Initial OD; maintenance 2× weekly

Clinical pearls

NICE NG23: vaginal oestrogen for genitourinary syndrome of menopause; safe long-term
Low systemic absorption — endometrial protection generally not required
British Menopause Society safety statements: appropriate even after breast cancer if non-hormonal options inadequate (specialist input)

Contraindications

Oestrogen-dependent malignancy (breast, endometrial)
Undiagnosed vaginal bleeding
Active VTE
Severe liver disease

Side effects

Local irritation
Mild systemic absorption (low)
Endometrial proliferation (rare with low-dose vaginal)

Interactions

Minimal systemic interactions at vaginal doses

Monitoring

Symptom response
Vaginal bleeding (if occurs investigate)

Reference: BNF; NICE NG23; British Menopause Society; https://bnf.nice.org.uk/drugs/estriol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways