Instructions

You have stated that you wish to have treatment with topical estradiol for the condition of vaginal dryness. This medication is estradiol cream 0.01% (0.1mg/g), typical dose is 0.5gm per application. For initial use, you will be instructed to use one dose every night for two weeks, then twice weekly ongoing. This allows an accelerated change to mature the cells of the vagina, normalize the pH, and maintain the changes for ongoing improvement of the vaginal tissue. Increasing moisture, elasticity, and comfort.

Use the applicator supplied with the cream. Wash hands before and after use. Fill the applicator with the prescribed amount of cream. Insert the applicator deep, but comfortably, into the vagina and push the plunger to expel the cream. Wash the applicator with warm soapy water and rinse well to allow reuse (do not use hot or boiling water). Use the amount as directed for the complete length of time prescribed.

Avoid using latex condoms, diaphragms, or cervical caps for up to 72 hours after using estrogen vaginal creams. Estrogen products may contain oils in the creams that can weaken latex (rubber) products and cause condoms to break or leak, or cervical caps or diaphragms to wear out sooner. Avoid exposing your male partner to your vaginal estrogen cream within 12 hours of administration to prevent absorption to your partner. You should stop this treatment 2 days before your scheduled pap smear to prevent affecting your results.

Refill

This medicine will be available for refills on an as needed basis or through an annual subscription—providing a 90 day supply at a time.

Allergies

This medicine, like all medications, may cause an allergic reaction if you are allergic to similar medicines or components. If you are allergic to any of the following please do not take the medicine and call or message us or see your primary care provider in person.

• Estrogens (Estradiol, ethinylestradiol)
  
  

Conditions

We have evaluated your health history and the specific health information you provided us, however if anything changes and you develop one of these conditions, please stop taking this medicine and call or message us immediately.

• Pregnancy
• Cancer
• Stroke
• Blood clot
• Clotting disorder (protein C, protein S, antithrombin deficiency)
• Heart disease/Heart attack
• Liver disease
• Porphyria
• Abnormal vaginal bleeding
  
  

Pregnancy and Breastfeeding

Based on available data, estradiol is not considered acceptable or safe for use in pregnancy.

Vaginal estradiol is considered safe for use while breastfeeding by ACOG. Estrogen is known to reduce breast milk production in some individuals. With vaginal estrogen very small amounts are absorbed into the bloodstream but levels are typically not high enough to significantly reduce breast milk production. In the rare instance that a reduction in breast milk production occurs, it can be reversed by stopping the vaginal estrogen cream.

Medicines, Supplements, and Foods

We have evaluated the specific health information you provided us, however if you are taking any of the medicines, foods, or supplements listed below call or message us before you take the medicine. Some of these can cause dangerous interactions with the medicine we are prescribing you and we will help you evaluate that risk and decide on an appropriate treatment plan. Please ensure your chart is up to date with your current medications, allergies, and medical conditions so your provider can safely treat you as this list may not be all inclusive.

• Aromatase inhibitors (anastrozole, exemestane, letrozole)
• Fusilic acid
• Fezolinetant
• Fulvestrant
• Hemin
• Ospemifene
• Raloxifene
• Tamoxifen
• Toremifene
• Tranexamic acid
• Grapefruit
  
  

Emergency Side Effects

This medicine can cause dangerous and potentially life-threatening side effects. If any of the emergency side effects listed in the manufacturer’s pamphlet or those below happen to you please stop taking the medicine and call 911 or seek immediate medical help in person.

• Sudden onset of chest pain
• Shortness of breath
• Difficulty or painful swallowing
• Severe skin rash and/or itching
• Facial or throat swelling
• Blurred vision
• Pain, redness, or swelling in the arm or leg
  
  

Other Side Effects

This medicine can also cause other side effects including:

• Vaginal bleeding
• Nausea
• Breast tenderness
• Change in vaginal discharge
• Clear or bloody discharge from the nipple
• Fast heartbeat
• Irritation
• Joint pain, stiffness, or swelling
• Lump in the breast or under the arm
• Pain or feeling of pressure in the pelvis
• Redness of the skin
  
  

Accurate Information

We have evaluated your health history and your specific health information you provided and determined it is safe to proceed with vaginal estrogen cream at this time. If your health history changes including diagnoses or medications please message or call us before you take the medicine to ensure it's safe to proceed. Some medications and conditions can cause dangerous interactions with the medicine we are prescribing and we will help you evaluate that risk and decide on an appropriate treatment plan.

Treatment Failure

This treatment is not guaranteed to be effective. It may not work or may only partially resolve the condition for which you are seeking treatment. If the treatment is not working, or if you are experiencing new or worsening symptoms, give us a call or message us anytime. If it is an emergency, call 911 or seek immediate medical help in person. You may need to seek alternative treatment such as those listed below or in the follow up plan.

Misdiagnosis or Delayed Diagnosis

Through telehealth, there is also a risk that we misdiagnose or fail to diagnose conditions that you may have which could affect our recommendation for treatment. This risk exists with an in-person medical provider as well but they may have additional resources to aid their evaluation. We use evidence-based practice and guidelines as well as clinical decision-making to minimize these risks.

Accepting or Declining Our Recommendation

We have based our recommendation on your specific case and medical guidelines, but there may be alternative treatments or strategies that may be helpful to you. Some may be more or less effective than what we provide. Some treatments may require an in-person exam or procedure which we can’t provide. Message us or talk to your primary care provider in person to discuss alternative treatments.

Share with Your In-Person Healthcare Team

You can access your records anytime. We strongly recommend that you update your in-person primary care provider, pharmacist, and the rest of your healthcare team to let them know about any new medicines you are taking or other changes in your health.

You can also ask us questions anytime and we are happy to help you share any information about your health with your in-person healthcare team.

Eligible estradiol patients are 40+, breastfeeding, and at least one year postpartum.