How safe are estrogen creams?

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In 2002, the National Women's Health Initiative halted a study of orally administered hormone replacement therapy (HRT) with oestrogen and progestin because of findings that indicated an increased risk of breast cancer. The phase of the study relating to orally administered HRT with oestrogen alone will continue through 2010. While there is some indication that oestrogen creams may be somewhat safer than orally administered HRT, women should always consult with their physicians for authoritative advice.

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How HRT Works

As women near the end of their reproductive years, their ovaries slowly diminish the process of ovulation, or egg production. Along with this process, levels of oestrogen diminish in the woman's body. This process often causes a number of troubling symptoms in women: Hot flushes, night sweats, insomnia and mood swings are among the most commonly reported.

HRT is designed to lessen these symptoms in prescribed doses of oestrogen alone or a combination of oestrogen and progestin. Oestrogen alone is usually prescribed for women who have undergone hysterectomies, while oestrogen in combination with progestin is usually prescribed for women with an intact uterus.

Uses for Estrogen Creams

HRT can be administered orally, through a patch applied to the skin, or in the form of vaginal creams. Vaginal creams may be applied directly or administered through vaginal rings that slowly release the medication into the system. Oestrogen creams are often prescribed to relieve vaginal dryness commonly but not exclusively associated with menopause. In higher doses, oestrogen creams can also be effective in relieving hot flushes and other menopausal symptoms.

Health Risks

There are conflicting reports on the safety of oestrogen in general and oestrogen creams in particular. According to a report issued by the Mayo Clinic, oestrogen alone can increase the risk of uterine cancer in women with an intact uterus. On the other hand, oestrogen combined with progestin can increase the risk of breast cancer. The Food and Drug Administration (FDA) requires oestrogen creams (as well as orally administered HRT) to carry warnings indicating possible increased health risks, including cancer.

However, a study conducted by the Robert Wood Johnson Medical School in New Brunswick, New Jersey, reported that conjugated oestrogen cream administered in low doses does not present elevated health risks to post-menopausal women. It should be noted that the study was sponsored by Wyeth, which manufactures Premarin, a major brand of HRT.

Oestrogen Creams vs. Orally Administered HRT

According to a report issued by the National Institutes of Health, oestrogen creams are preferred to orally administered HRT for symptoms associated with vaginal dryness. This is because the levels of oestrogen absorbed by the body are lower with most oestrogen creams than with oral HRT. The study also recommends that any form of HRT, including oestrogen creams, should be prescribed in the lowest dose and for the shortest time possible to achieve effective relief of symptoms.

The Estriol Controversy

In 2008, the FDA administered a ban preventing compounding pharmacists from including estriol in the creams they formulate to relieve vaginal dryness and related symptoms. Estriol is a naturally occurring hormone in the human body, as opposed to conventional conjugated oestrogen cream, which is formulated from the urine of pregnant mares.

Before the ban, estriol was used by compounding pharmacies in combination with estradiol in formulating oestrogen cream. In response, the House of Representatives introduced H. CON. RES. 342, a resolution condemning the ban on estriol by the FDA. However, as of 2009, no further action has been taken on the matter. Estradiol is still used as an alternative to conjugated oestrogen creams.

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