Estradiol vaginal cream is a prescription medication designed for localized treatment of symptoms related to vulvar and vaginal atrophy, conditions often experienced following menopause. This low-dose therapy delivers the hormone directly to the affected tissues, helping to address issues like dryness, burning, and pain during intercourse. The medication is absorbed by the vaginal lining to restore tissue thickness and elasticity. This treatment is distinct from systemic hormone replacement therapy, as its primary action is concentrated within the vaginal area.
Preparing for Application
Before beginning the administration process, proper preparation ensures the correct dosage and limits the risk of contamination. Always begin by washing your hands thoroughly with soap and water to maintain hygiene. The prescribing physician will provide specific dosing instructions, which can range from an initial higher dose (e.g., 2 to 4 grams daily) to a lower maintenance dose (e.g., 1 gram one to three times per week) as symptoms improve.
The reusable applicator provided with the cream is designed with specific markings, typically indicating measurements from 1 gram up to 4 grams. To load the applicator, first ensure the plunger is fully pushed into the barrel. Next, screw the open end of the applicator onto the threaded tip of the cream tube. Gently squeeze the tube from the bottom until the cream fills the applicator barrel, pushing the inner plunger backward until the designated dosage line is reached. Once the correct amount is loaded, unscrew the applicator from the tube and securely replace the cap on the cream tube.
The Step-by-Step Application Process
Once the applicator is filled, the next step is comfortable positioning for insertion. Many individuals find it easiest to lie on their back with their knees bent and feet flat, or to stand with one foot elevated on a stable surface. This positioning helps relax the pelvic muscles, making the insertion process smoother. Most healthcare providers recommend using the cream at bedtime to maximize absorption and minimize leakage.
With the cream-filled applicator in hand, gently insert the barrel into the vagina, similar to inserting a tampon. The applicator should be inserted as far as is comfortable, typically reaching the upper third of the vaginal canal to ensure the cream is distributed effectively. Once positioned, steadily push the plunger inward until it stops, fully dispensing the entire prescribed dose of cream into the vagina.
After the cream has been delivered, hold the plunger in its depressed position as you slowly and carefully withdraw the entire applicator from the body. Keeping the plunger depressed during removal prevents the vacuum action from drawing any of the medication back into the applicator barrel. Some minor cream leakage after application is normal, and wearing a sanitary pad or pantyliner overnight can help protect clothing.
Handling Missed Doses and Storage
If a dose of estradiol cream is missed, apply it as soon as you remember. If it is already close to the time for the next scheduled dose, skip the missed dose entirely and resume the regular dosing schedule. Never double the dose to compensate for the skipped application, as this does not improve treatment effectiveness and may increase the risk of side effects. If there is uncertainty about the timing of the next dose, consult the patient information leaflet or contact a pharmacist.
For the reusable applicator, proper cleaning after each use is necessary to maintain hygiene. First, the applicator should be disassembled by pulling the plunger completely out of the barrel. Wash both pieces separately using warm water and a mild, non-detergent soap, ensuring that all cream residue is thoroughly removed. Avoid using extremely hot or boiling water, as this can damage or warp the plastic components of the device.
After washing, both the plunger and the barrel should be rinsed well with clean water to remove all traces of soap residue. Allow the pieces to air-dry completely before reassembling them for storage. The cream tube itself should be stored in a closed container at room temperature, safely away from heat, excessive moisture, and direct light, and should be kept out of the reach of children.