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OVESTIN 1MG CREAM

Active substance(s): ESTRIOL

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How likely is breast cancer?

Package leaflet: Information for the user
Ovestin® 1mg Cream
(estriol)

Looking at women aged 50, on average, by the time they reach 65:

Variation 3 - To add a new manufacturer.
• previously
In women assessed
not taking
HRT: UK
32 in
get breast
cancer.
This version replaces PIL dated 25.11.2014,
against
PIL1,000
datedwill
September
2014.

In women who start taking oestrogen-only HRT at age 50 and take it for 5 years: between 33
A Chohan. 20 June 2016

Your medicine is available using the name Ovestin 1mg Cream but will be referred to as Ovestin Cream
throughout this leaflet.
Read all of this leaflet carefully before you start using this medicine.





In
1.
2.
3.
4.
5.
6.
1.

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if
their symptoms are the same as yours.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.

You do not need to take a separate progestogen with Ovestin Cream.

this leaflet:
What Ovestin Cream is and what it is used for
Before you use Ovestin Cream
How to use Ovestin Cream
Possible side effects
How to store Ovestin Cream
Further information

If you get breakthrough bleeding or spotting, it is usually nothing to worry about, but you should:
→ Talk to your doctor. It could be a sign that your endometrium has become thicker.

Ovarian cancer

Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose,
because there are often no obvious signs of the problem. Some studies have shown that taking
oestrogen – only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet
known whether other kinds of HRT increase the risk in the same way.

WHAT OVESTIN CREAM IS AND WHAT IT IS USED FOR

2.4 Ovestin Cream and the heart or circulation
Heart disease

HRT is not recommended for women who have had heart disease recently. If you have ever
had heart disease, talk to your doctor to see if you should be taking HRT.

Ovestin Cream is used:

HRT will not help to prevent heart disease.

For vaginal problems caused by having too little ‘oestrogen’
Before or after vaginal surgery to help wound healing.

How Ovestin Cream works

Estriol (the medicine in Ovestin Cream) is one of the natural oestrogens.
Oestrogens are female sex hormones.
They are produced in the ovaries.
They cause sexual development in women and control the menstrual cycle during the child-bearing
years.

BEFORE YOU USE OVESTIN CREAM

If you get a pain in your chest that spreads to your arm or neck:
→ See a doctor as soon as possible
Do not use any more HRT until a doctor says you can. This pain could be a sign of heart disease.
Research suggests that HRT slightly increases the risk of having a stroke.
Other things that can increase the risk of stroke include:

This happens at the menopause (usually around the age of 50).
If the ovaries are removed before the menopause, oestrogen production stops very suddenly.

Shortage of oestrogens may cause the vaginal wall to become thin and dry. So sexual intercourse may
become painful and you may get vaginal infections. These problems can be relieved by using medicines
like Ovestin which contain oestrogen. It may take several days or weeks before you notice an
improvement.

2.

Studies with one type of HRT (containing a progestogen, and a different oestrogen to the one in
Ovestin Cream) have shown that women may be slightly more likely to get heart disease during the
first year of taking that type of HRT.
For other types of HRT (like Ovestin Cream), the risk is likely to be similar. However this is not yet
certain.

Stroke

When women get older the ovaries gradually produce less oestrogen.



If you notice any changes in your breast, such as: dimpling of your skin, changes in your nipple or
any lumps you can see or feel:
→ Make an appointment to see your doctor straight away.
Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer
of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used
directly in the vagina for repeated treatments or over a long time.

What is Ovestin Cream used for





and 34 in 1,000 will get breast cancer. This means an extra 1 to 2 cases.
In women taking oestrogen-only HRT for 10 years: 37 in 1,000 will get breast cancer. This
means an extra 5 cases.

Endometrial cancer (cancer of the lining of the womb)

Ovestin Cream contains a medicine called estriol. It belongs to a group of medicines called Hormone
Replacement Therapy (HRT).







getting older

high blood pressure

smoking

drinking too much alcohol

an uneven heartbeat
If you are worried about any of these things, or if you have had a stroke in the past, talk to your
doctor to see if you should take HRT.

As well as benefits, HRT has some risks that you need to consider when you’re deciding whether to
start taking it, or whether to carry on taking it. This is especially important if you are more than 60
years old.

How likely is a stroke?

Before you start taking HRT




Your doctor should ask about you and your family’s medical history. Your doctor may decide to
examine your breasts or your stomach and may do an internal examination. They will only do this if it
is necessary for you or you have any special concerns.


Tell your doctor if you have any medical problems or illnesses.

Regular check-ups

Once you have started on HRT, see your doctor for regular check-ups (at least once a year). At these
check-ups, your doctor may discuss the benefits and risks of continuing to take HRT.

Make sure that you:



go for regular breast screening and cervical smear tests
regularly check your breasts for any changes such as dimpling of the skin, changes in the
nipple, or any lumps you can see or feel.

2.1 Do not use Ovestin Cream if:











you are allergic (hypersensitive) to any of the ingredients of Ovestin (listed in Section 6)
you have had angina or a heart attack (myocardial infarction)
you have had a blood clot (thrombosis)
you have had breast cancer or suspect that you have breast cancer
you have had cancer of other sex organs – such as cancer of the womb lining or ovary
you have vaginal bleeding that has not been explained by your doctor
you have excessive thickening of the womb lining
you have had a liver disease, and your liver is still not working properly
you have a rare blood problem called ‘porphyria’.
Do not use this medicine if any of the above apply to you. If you are not sure, talk to your
doctor or pharmacist before using Ovestin Cream.

2.2 Take special care with Ovestin Cream
Check with your doctor or pharmacist before using your medicine if you have had:













a problem caused by growth of the womb lining outside the womb (fibroids or endometriosis)
any problem with your heart or circulation (including high blood pressure or risk factors for a blood
clot – see Section 2.4)
relatives who have had blood clots
asthma
diabetes
migraine or severe headaches
epilepsy (fits)
gallstones
liver or kidney problems
a rare problem called ‘systemic lupus erythematosus’ (SLE)
otosclerosis (a hearing disorder).
If you have any of these, talk to your doctor or pharmacist before using Ovestin Cream.

Ovestin Cream contains cetyl alcohol and stearyl alcohol. This may cause local skin reactions
(e.g. contact dermatitis).

2.3 Ovestin Cream and the risk of developing cancer
Breast cancer

Women who have ever had breast cancer should not take HRT.
Taking HRT slightly increases the risk of breast cancer. The risk is also slightly increased if you have a
later menopause. The risk after the menopause for a woman taking oestrogen-only HRT for 5 years is
about the same as for a woman of the same age who is still having periods over that time and not
taking HRT. The risk for a woman who is taking oestrogen plus progestogen HRT is higher than for
oestrogen-only HRT. However, oestrogen plus progestogen HRT is beneficial for the endometrium.
For all kinds of HRT, the extra risk of breast cancer goes up the longer you take it. However, it returns
to normal about 5 years after stopping HRT.
Your risk of breast cancer is also higher if:



Looking at women in their 50s, on average, over 5 years
In women not taking HRT: 3 in 1,000 would be expected to have a stroke.
In women taking HRT: 4 in 1,000 would be expected to have a stroke.

Looking at women in their 60s, on average, over 5 years



In women not taking HRT: 11 in 1,000 would be expected to have a stroke.
In women taking HRT: 15 in 1,000 would be expected to have a stroke.

If you get an unexpected migraine-type headache, with or without disturbed vision:
→ See a doctor straight away, and do not use any more HRT until a doctor says you can. These
headaches may be an early warning sign of a stroke.

Blood clots

HRT may increase the risk of blood clots in the veins (also called deep vein thrombosis, or DVT).
This is especially during the first year of taking it.
These blood clots are not always serious. However, if a clot travels to your lungs, it can cause
chest pain, feeling breathless, collapse or even death. This is called a pulmonary embolism or PE.

You are more likely to get a blood clot if:









you are very overweight
you have had a blood clot before
any of your close family have had blood clots
you have ever had a miscarriage
you have any blood clotting problem that needs treatment with a medicine such as warfarin
you are off your feet for a long time because of major surgery, injury or illness
you have a rare problem called SLE.
If any of these things apply to you, talk to your doctor to see if you should take HRT.

How likely is a blood clot?
Looking at women in their 50s, on average, over 5 years:



In women not taking HRT: 3 in 1,000 would be expected to get a blood clot.
In women taking HRT: 7 in 1,000 would be expected to get a blood clot.

Looking at women in their 60s, on average, over 5 years:



In women not taking HRT: 8 in 1,000 would be expected to get a blood clot.
In women taking HRT: 17 in 1,000 would be expected to get a blood clot.

If you get painful swelling in your leg, sudden chest pain or have problems breathing:


See a doctor straight away

Do not use any more HRT until a doctor says you can.
These may be signs of a blood clot.

2.5 Taking other medicines
Tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This
includes medicines obtained without a prescription, including herbal medicines. This is because Ovestin
Cream can affect the way some other medicines work. Also some other medicines can affect the way
Ovestin Cream works.


Tell your doctor or pharmacist if you are taking any of the following:






medicines for epilepsy – such as barbiturates, hydantoins and carbamezapine.
medicines for infections – such as griseofulvin and rifamycins.
medicines for viral infections – such as nevirapine, efavirenz, ritonavir or nelfinavir.
herbal preparations containing St John’s wort (Hypericum perforatum) – a herbal medicine used for
depression.
one of the following medicines: corticosteroids, succinylcholine, theophyllines or troleandomycin.



If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using
Ovestin Cream.
If you have a vaginal infection, your doctor may also prescribe a medicine to treat the infection.

you have a close relative (mother, sister or grandmother) who has had breast cancer
you are seriously overweight.

Page 1 of 2

4.

2.6 Operations


Tell your doctor you are using Ovestin Cream if you are going to have surgery. You may need to
stop using HRT about 4 to 6 weeks before the operation to reduce the risk of a blood clot. Your
doctor will tell you when you can start taking HRT again.



2.7 Pregnancy and breast-feeding



Do not use Ovestin Cream if you are pregnant or might become pregnant. This is because it may
affect the baby.
Do not breast-feed if you are using this medicine.

Other side effects include:

2.8 Driving and using machines



Ovestin Cream has no or little effect on the ability to drive or use machines.









HOW TO USE OVESTIN CREAM

Always use Ovestin Cream exactly as your doctor or pharmacist has told you. You should check with
your doctor or pharmacist if you are not sure.




If you have had your womb and ovaries removed, you can start using Ovestin Cream straight
away.
If you have never used HRT before or if you are changing over from a period-free HRT, you can
also use Ovestin Cream straight away.
If you are changing over from another type of HRT where you have a period, start using Ovestin
Cream one week after you finish the other HRT.

HRT will not prevent memory loss. In one study of women who started using combined HRT after the
age of 65, a small increase in the risk of dementia was observed.


For vaginal problems

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via the
Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects, you can help provide more information on the safety of this medicine.

Before or after vaginal surgery
Before surgery – the dose is 1 applicator up to the ring (0.5 mg estriol in 0.5g of cream) a day for
2 weeks before the operation.
After surgery – do not use the cream again for at least 2 weeks. Then use 1 applicator up to the
ring twice a week.

Ovestin Cream comes in a pack together with a clear plastic applicator.
Use the applicator to apply the cream in the vagina. A good time to do this is before going to bed.

HOW TO STORE OVERSTIN CREAM

6.

FURTHER INFORMATION

What Ovestin Cream contains

The applicator has a ring marked on the body. Fill the applicator up to the ring mark with Ovestin
Cream to get the correct dose.

2.

5.

Keep out of the sight and reach of children.
Do not use this medicine after the expiry date on the pack. The expiry date refers to the last day of
that month.
Do not store above 25°C. Do not freeze.
If your medicine appears discoloured, or shows any other signs of deterioration, take it to your
pharmacist who will advise you.
If your doctor tells you to stop using the medicine, please take the medicine back to the pharmacist for
safe disposal. Only keep the medicine if your doctor tells you to.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to
dispose of medicines no longer required. These measures will help protect the environment.

3.2 How to apply the cream


1.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, tell
your doctor or pharmacist.

Reporting of side effects

The usual dose is 1 applicator up to the ring (0.5mg estriol in 0.5g of cream) a day for the first 2
to 3 weeks.

Then the dose is 1 applicator up to the ring twice a week.
Your doctor will prescribe the lowest dose that relieves your symptoms. Your doctor may want you to
stop from time to time (every 2 to 3 months for a period of 4 weeks). This is to check if you still need
treatment.





irritation or itching of the skin in or around your vagina when you start to use Ovestin Cream. This
usually gets better after a few weeks.
increased vaginal discharge, bleeding or spotting
gall bladder problems
skin problems such as a rash or an allergy to the sun
breasts become swollen, tender or painful
headaches
feeling sick or being sick.
If you have any of these side effects tell your doctor. They may decide to stop your treatment for
a while.

Dementia

3.1 How much to use



See your doctor straight away, if you notice any of the following serious side effects –
your doctor may decide to stop you using the cream:


your blood pressure rises

your skin or the whites of your eyes go yellow (jaundice)

you suddenly have migraine-type headaches (see Section 2.4 above)

you have signs of a blood clot (see Section 2.4 above)

you have any of the problems listed in Section 2.1 above.
These side effects are rare.

Ask your doctor or pharmacist for advice before taking any medicine, if you are pregnant or breastfeeding.

3.

POSSIBLE SIDE EFFECTS

Like all medicines, Ovestin Cream can cause side effects, although not everybody gets them.




Follow these instructions:

Remove the cap from the tube and turn the cap upside down. Then use the sharp point to open
the tube.
Screw the end of the applicator onto the tube.

The active substance is estriol. Each gram of cream contains 1mg of estriol.
The other ingredients are octyldodecanol, glycerine, cetyl alcohol, stearyl alcohol, polysorbate 60,
sorbitan stearate, lactic acid, chlorhexidine hydrochloride, sodium hydroxide, purified water and
cetyl palmitate.

What Ovestin Cream looks like and the contents of the pack




White to off-white, smooth, homogenous cream.
Each tube contains 15g of cream.
The pack contains a clear plastic applicator.

Manufacturer

Manufactured by: Organon Ireland, Ltd., Drynam Road – Swords County Dublin, 2857 – County Dublin,
Ireland.
Or
Aspen Bad Oldesloe GmbH, Industriestrasse 32-36, D-23843 Bad Oldesloe, Germany.

3.

Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall,
Doncaster, DN3 1QR.

Squeeze the tube to fill the applicator with the cream up to the red ring mark (the plunger will
stop at the red ring mark).

Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
Leaflet issue and revision date (Ref): 18.04.16
PL No: 21828/0623

POM

Ovestin® is a registered trademark of N.V. Organon.
To listen to or request a copy of this leaflet in Braille, large print or audio, please call 01302 365000
and ask for the Regulatory Department.

4.
5.

Please be ready to give the following information:
Product name
Ovestin 1mg Cream
Reference number
21828/0623

Unscrew the applicator from the tube and put the cap back on the tube.
To apply the cream, lie down, put the end of the applicator deep into your vagina and slowly
push the plunger all the way in.

Cleaning the applicator





After use, pull the plunger out of the barrel.
Wash the plunger and barrel in hand hot, soapy water.
Do not use detergents. Rinse well with clean water afterwards.
Do not put the applicator in boiling water.

Ovestin Cream is easy to remove with water.

3.3 If you use more Ovestin Cream than you should or if you swallow it
accidentally
If someone has swallowed some cream by accident, or too much cream is applied at any time, there is
no need to worry. However, you should talk to your doctor. The person may feel sick or be sick.
Women may have some vaginal bleeding after a few days.

3.4 If you forget to use Ovestin Cream



Apply the missed dose when you remember, unless you are more than 12 hours late.
If you are more than 12 hours late just skip the missed dose.

3.5 If you stop using Ovestin Cream
Keep using this medicine as prescribed by your doctor. Keep using Ovestin Cream, even if you seem to
be better. If you stop too early or too suddenly your problem may return.

Page 2 of 2

How likely is breast cancer?

Estriol 1mg Vaginal Cream

Looking at women aged 50, on average, by the time they reach 65:



PATIENT INFORMATION LEAFLET
Your medicine is available using the name Estriol 1mg Vaginal Cream but will be referred to as Estriol
Cream throughout this leaflet.



Read all of this leaflet carefully before you start using this medicine.





In
1.
2.
3.
4.
5.
6.
1.

If you notice any changes in your breast, such as: dimpling of your skin, changes in your nipple or
any lumps you can see or feel:
→ Make an appointment to see your doctor straight away.

Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if
their symptoms are the same as yours.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.

Endometrial cancer (cancer of the lining of the womb)

Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer
of the lining of the womb. It is possible there may be a similar risk with oestrogen cream used
directly in the vagina for repeated treatments or over a long time.

this leaflet:
What Estriol Cream is and what it is used for
Before you use Estriol Cream
How to use Estriol Cream
Possible side effects
How to store Estriol Cream
Further information

You do not need to take a separate progestogen with Estriol Cream.
If you get breakthrough bleeding or spotting, it is usually nothing to worry about, but you should:
→ Talk to your doctor. It could be a sign that your endometrium has become thicker.

Ovarian cancer

Ovarian cancer (cancer of the ovaries) is very rare, but it is serious. It can be difficult to diagnose,
because there are often no obvious signs of the problem. Some studies have shown that taking
oestrogen – only HRT for more than 5 years may increase the risk of ovarian cancer. It is not yet
known whether other kinds of HRT increase the risk in the same way.

WHAT ESTRIOL CREAM IS AND WHAT IT IS USED FOR

Estriol Cream contains a medicine called estriol. It belongs to a group of medicines called Hormone
Replacement Therapy (HRT).

2.4 Estriol Cream and the heart or circulation
Heart disease

What is Estriol Cream used for

HRT is not recommended for women who have had heart disease recently. If you have ever
had heart disease, talk to your doctor to see if you should be taking HRT.

Estriol Cream is used:



For vaginal problems caused by having too little ‘oestrogen’
Before or after vaginal surgery to help wound healing.

HRT will not help to prevent heart disease.
Studies with one type of HRT (containing a progestogen, and a different oestrogen to the one in Estriol
Cream) have shown that women may be slightly more likely to get heart disease during the first year
of taking that type of HRT.

How Estriol Cream works

Estriol (the medicine in Estriol Cream) is one of the natural oestrogens.




Oestrogens are female sex hormones.
They are produced in the ovaries.
They cause sexual development in women and control the menstrual cycle during the child-bearing
years.

When women get older the ovaries gradually produce less oestrogen.



This happens at the menopause (usually around the age of 50).
If the ovaries are removed before the menopause, oestrogen production stops very suddenly.

BEFORE YOU USE ESTRIOL CREAM

As well as benefits, HRT has some risks that you need to consider when you’re deciding whether to
start taking it, or whether to carry on taking it. This is especially important if you are more than 60
years old.

Before you start taking HRT

Your doctor should ask about you and your family’s medical history. Your doctor may decide to
examine your breasts or your stomach and may do an internal examination. They will only do this if it
is necessary for you or you have any special concerns.


Tell your doctor if you have any medical problems or illnesses.

For other types of HRT (like Estriol Cream), the risk is likely to be similar. However this is not yet
certain.
If you get a pain in your chest that spreads to your arm or neck:
→ See a doctor as soon as possible
Do not use any more HRT until a doctor says you can. This pain could be a sign of heart disease.

Stroke

Shortage of oestrogens may cause the vaginal wall to become thin and dry. So sexual intercourse may
become painful and you may get vaginal infections. These problems can be relieved by using medicines
like Estriol which contain oestrogen. It may take several days or weeks before you notice an
improvement.

2.

In women not taking HRT: 32 in 1,000 will get breast cancer.
In women who start taking oestrogen-only HRT at age 50 and take it for 5 years: between 33
and 34 in 1,000 will get breast cancer. This means an extra 1 to 2 cases.
In women taking oestrogen - only HRT for 10 years: 37 in 1,000 will get breast cancer. This
means an extra 5 cases.

Research suggests that HRT slightly increases the risk of having a stroke.
Other things that can increase the risk of stroke include:

getting older

high blood pressure

smoking

drinking too much alcohol

an uneven heartbeat
If you are worried about any of these things, or if you have had a stroke in the past, talk to your
doctor to see if you should take HRT.

How likely is a stroke?

Looking at women in their 50s, on average, over 5 years



In women not taking HRT: 3 in 1,000 would be expected to have a stroke.
In women taking HRT: 4 in 1,000 would be expected to have a stroke.

Looking at women in their 60s, on average, over 5 years
In women not taking HRT: 11 in 1,000 would be expected to have a stroke.
In women taking HRT: 15 in 1,000 would be expected to have a stroke.

Regular check-ups




Make sure that you:

If you get an unexpected migraine-type headache, with or without disturbed vision:
→ See a doctor straight away, and do not use any more HRT until a doctor says you can. These
headaches may be an early warning sign of a stroke.

Once you have started on HRT, see your doctor for regular check-ups (at least once a year). At these
check-ups, your doctor may discuss the benefits and risks of continuing to take HRT.




go for regular breast screening and cervical smear tests
regularly check your breasts for any changes such as dimpling of the skin, changes in the
nipple, or any lumps you can see or feel.

2.1 Do not use Estriol Cream if:











you are allergic (hypersensitive) to any of the ingredients of Estriol (listed in Section 6)
you have had angina or a heart attack (myocardial infarction)
you have had a blood clot (thrombosis)
you have had breast cancer or suspect that you have breast cancer
you have had cancer of other sex organs – such as cancer of the womb lining or ovary
you have vaginal bleeding that has not been explained by your doctor
you have excessive thickening of the womb lining
you have had a liver disease, and your liver is still not working properly
you have a rare blood problem called ‘porphyria’.
Do not use this medicine if any of the above apply to you. If you are not sure, talk to your
doctor or pharmacist before using Estriol Cream.

2.2 Take special care with Estriol Cream
Check with your doctor or pharmacist before using your medicine if you have had:













a problem caused by growth of the womb lining outside the womb (fibroids or endometriosis)
any problem with your heart or circulation (including high blood pressure or risk factors for a blood
clot – see Section 2.4)
relatives who have had blood clots
asthma
diabetes
migraine or severe headaches
epilepsy (fits)
gallstones
liver or kidney problems
a rare problem called ‘systemic lupus erythematosus’ (SLE)
otosclerosis (a hearing disorder).
If you have any of these, talk to your doctor or pharmacist before using Estriol Cream.

Estriol Cream contains cetyl alcohol and stearyl alcohol. This may cause local skin reactions
(e.g. contact dermatitis).

2.3 Estriol Cream and the risk of developing cancer
Breast cancer

Blood clots

HRT may increase the risk of blood clots in the veins (also called deep vein thrombosis, or DVT).
This is especially during the first year of taking it.
These blood clots are not always serious. However, if a clot travels to your lungs, it can cause
chest pain, feeling breathless, collapse or even death. This is called a pulmonary embolism or PE.

You are more likely to get a blood clot if:









you are very overweight
you have had a blood clot before
any of your close family have had blood clots
you have ever had a miscarriage
you have any blood clotting problem that needs treatment with a medicine such as warfarin
you are off your feet for a long time because of major surgery, injury or illness
you have a rare problem called SLE
If any of these things apply to you, talk to your doctor to see if you should take HRT.

How likely is a blood clot?
Looking at women in their 50s, on average, over 5 years:



In women not taking HRT: 3 in 1,000 would be expected to get a blood clot.
In women taking HRT: 7 in 1,000 would be expected to get a blood clot.

Looking at women in their 60s, on average, over 5 years:



In women not taking HRT: 8 in 1,000 would be expected to get a blood clot.
In women taking HRT: 17 in 1,000 would be expected to get a blood clot.

If you get painful swelling in your leg, sudden chest pain or have problems breathing:


See a doctor straight away

Do not use any more HRT until a doctor says you can.
These may be signs of a blood clot.

2.5 Taking other medicines
Tell your doctor or pharmacist if you are taking or have recently taken any other medicines. This
includes medicines obtained without a prescription, including herbal medicines. This is because Estriol
Cream can affect the way some other medicines work. Also some other medicines can affect the way
Estriol Cream works.


Women who have ever had breast cancer should not take HRT.
Taking HRT slightly increases the risk of breast cancer. The risk is also slightly increased if you have a
later menopause. The risk after the menopause for a woman taking oestrogen-only HRT for 5 years is
about the same as for a woman of the same age who is still having periods over that time and not
taking HRT. The risk for a woman who is taking oestrogen plus progestogen HRT is higher than for
oestrogen-only HRT. However, oestrogen plus progestogen HRT is beneficial for the endometrium.



Tell your doctor or pharmacist if you are taking any of the following:






For all kinds of HRT, the extra risk of breast cancer goes up the longer you take it. However, it returns
to normal about 5 years after stopping HRT.



medicines for epilepsy – such as barbiturates, hydantoins and carbamezapine.
medicines for infections – such as griseofulvin and rifamycins.
medicines for viral infections – such as nevirapine, efavirenz, ritonavir or nelfinavir.
herbal preparations containing St John’s wort (Hypericum perforatum) – a herbal medicine used for
depression.
one of the following medicines: corticosteroids, succinylcholine, theophyllines or troleandomycin.

Your risk of breast cancer is also higher if:



you have a close relative (mother, sister or grandmother) who has had breast cancer
you are seriously overweight.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using
Estriol Cream.
If you have a vaginal infection, your doctor may also prescribe a medicine to treat the infection.

Page 1 of 2

4.

2.6 Operations


Tell your doctor you are using Estriol Cream if you are going to have surgery. You may need to
stop using HRT about 4 to 6 weeks before the operation to reduce the risk of a blood clot. Your
doctor will tell you when you can start taking HRT again.



2.7 Pregnancy and breast-feeding



Do not use Estriol Cream if you are pregnant or might become pregnant. This is because it may
affect the baby.
Do not breast-feed if you are using this medicine.

Other side effects include:

2.8 Driving and using machines



Estriol Cream has no or little effect on the ability to drive or use machines.









HOW TO USE ESTRIOL CREAM

Always use Estriol Cream exactly as your doctor or pharmacist has told you. You should check with
your doctor or pharmacist if you are not sure.




See your doctor straight away, if you notice any of the following serious side effects –
your doctor may decide to stop you using the cream:


your blood pressure rises

your skin or the whites of your eyes go yellow (jaundice)

you suddenly have migraine-type headaches (see Section 2.4 above)

you have signs of a blood clot (see Section 2.4 above)

you have any of the problems listed in Section 2.1 above.
These side effects are rare.

Ask your doctor or pharmacist for advice before taking any medicine, if you are pregnant or breastfeeding.

3.

POSSIBLE SIDE EFFECTS

Like all medicines, Estriol Cream can cause side effects, although not everybody gets them.

If you have had your womb and ovaries removed, you can start using Estriol Cream straight away.
If you have never used HRT before or if you are changing over from a period-free HRT, you can
also use Estriol Cream straight away.
If you are changing over from another type of HRT where you have a period, start using Estriol
Cream one week after you finish the other HRT.

irritation or itching of the skin in or around your vagina when you start to use Estriol Cream. This
usually gets better after a few weeks.
increased vaginal discharge, bleeding or spotting
gall bladder problems
skin problems such as a rash or an allergy to the sun
breasts become swollen, tender or painful
headaches
feeling sick or being sick.
If you have any of these side effects tell your doctor. They may decide to stop your treatment for
a while.

Dementia

HRT will not prevent memory loss. In one study of women who started using combined HRT after the
age of 65, a small increase in the risk of dementia was observed.

3.1 How much to use



For vaginal problems

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, tell
your doctor or pharmacist.

The usual dose is 1 applicator up to the ring (0.5mg estriol in 0.5g of cream) a day for the first 2
to 3 weeks.

Then the dose is 1 applicator up to the ring twice a week.
Your doctor will prescribe the lowest dose that relieves your symptoms. Your doctor may want you to
stop from time to time (every 2 to 3 months for a period of 4 weeks). This is to check if you still need
treatment.

Reporting of side effects

Before or after vaginal surgery

5.

HOW TO STORE ESTRIOL CREAM

6.

FURTHER INFORMATION






If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via the
Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects, you can help provide more information on the safety of this medicine.
Keep out of the sight and reach of children.
Do not use this medicine after the expiry date on the pack. The expiry date refers to the last day of
that month.
Do not store above 25°C. Do not freeze.
If your medicine appears discoloured, or shows any other signs of deterioration, take it to your
pharmacist who will advise you.
If your doctor tells you to stop using the medicine, please take the medicine back to the pharmacist for
safe disposal. Only keep the medicine if your doctor tells you to.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to
dispose of medicines no longer required. These measures will help protect the environment.

Before surgery – the dose is 1 applicator up to the ring (0.5 mg estriol in 0.5g of cream) a day for
2 weeks before the operation.
After surgery – do not use the cream again for at least 2 weeks. Then use 1 applicator up to the
ring twice a week.

3.2 How to apply the cream
Estriol Cream comes in a pack together with a clear plastic applicator.
Use the applicator to apply the cream in the vagina. A good time to do this is before going to bed.
The applicator has a ring marked on the body. Fill the applicator up to the ring mark with Estriol Cream
to get the correct dose.

1.
2.

Follow these instructions:

Remove the cap from the tube and turn the cap upside down. Then use the sharp point to open
the tube.
Screw the end of the applicator onto the tube.

What Estriol Cream contains



The active substance is estriol. Each gram of cream contains 1mg of estriol.
The other ingredients are octyldodecanol, glycerine, cetyl alcohol, stearyl alcohol, polysorbate 60,
sorbitan stearate, lactic acid, chlorhexidine hydrochloride, sodium hydroxide, purified water and
cetyl palmitate.

What Estriol Cream looks like and the contents of the pack




White to off-white, smooth, homogenous cream.
Each tube contains 15g of cream.
The pack contains a clear plastic applicator.

Manufacturer

Manufactured by: Organon Ireland, Ltd., Drynam Road – Swords County Dublin, 2857 – County Dublin,
Ireland.
Or
Aspen Bad Oldesloe GmbH, Industriestrasse 32-36, D-23843 Bad Oldesloe, Germany.
3.

Squeeze the tube to fill the applicator with the cream up to the red ring mark (the plunger will
stop at the red ring mark).

Procured from within the EU and repackaged by: Doncaster Pharmaceuticals Group Ltd., Kirk Sandall,
Doncaster, DN3 1QR.
Product Licence holder: Landmark Pharma Ltd., 7 Regents Drive, Prudhoe, Northumberland, NE42 6PX.
Leaflet issue and revision date (Ref): 18.04.16
PL No: 21828/0623

POM

To listen to or request a copy of this leaflet in Braille, large print or audio, please call 01302 365000
and ask for the Regulatory Department.

4.
5.

Unscrew the applicator from the tube and put the cap back on the tube.
To apply the cream, lie down, put the end of the applicator deep into your vagina and slowly
push the plunger all the way in.

Please be ready to give the following information:
Product name
Estriol 1mg Vaginal Cream
Reference number
21828/0623

Cleaning the applicator





After use, pull the plunger out of the barrel.
Wash the plunger and barrel in hand hot, soapy water.
Do not use detergents. Rinse well with clean water afterwards.
Do not put the applicator in boiling water.

Estriol Cream is easy to remove with water.

3.3 If you use more Estriol Cream than you should or if you swallow it
accidentally
If someone has swallowed some cream by accident, or too much cream is applied at any time, there is
no need to worry. However, you should talk to your doctor. The person may feel sick or be sick.
Women may have some vaginal bleeding after a few days.

3.4 If you forget to use Estriol Cream



Apply the missed dose when you remember, unless you are more than 12 hours late.
If you are more than 12 hours late just skip the missed dose.

3.5 If you stop using Estriol Cream
Keep using this medicine as prescribed by your doctor. Keep using Estriol Cream, even if you seem to
be better. If you stop too early or too suddenly your problem may return.

Page 2 of 2

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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