Does Estrace Cream Come In A Vaginal Tablet?

In our latest question and answer, our pharmacist discusses alternative vaginal estradiol options to Estrace vaginal cream.

Question

I take Estrace (estradiol) cream, 1 gram once a week. Is there an equivalent oral tablet dose that could be used vaginally? If so, would a 1 mg tablet be equivalent to 1 gram in cream form? I'm asking because the oral medication is significantly cheaper. Thank you for your help.

Asked by Veronica On May 02, 2023

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published May 08, 2023
Last updated Jun 08, 2024

Key points

  • Vaginal estradiol tablets are available, but they are lower strength and have different absorption properties compared to the Estrace vaginal cream, making it challenging to determine an exact dose for dose change. Generally, they produce lower systemic estrogen concentrations when compared to Estrace cream.
  • Oral estradiol tablets are available but not intended for vaginal administration, and they are available in higher dosages than vaginal products. Using them vaginally is not recommended due to little safety and efficacy data. The safer options are using generic vaginal estradiol tablets or Estrace cream, which is also available generically.

Answer

Thanks for reaching out! There are a number of different vaginal estradiol products available on the market, including the one you are taking, Estrace, which is a vaginal cream. There are vaginal estradiol tablets available as well, but the tablets are lower strength and don't have exactly the same absorption properties, so it's challenging to determine an exact dose for dose change.

You specifically asked whether or not there is an oral estradiol tablet available, which there is, but they are not intended for vaginal administration. They are available in higher dosages than vaginal products too. While I certainly have seen some prescribers prescribe their patient's oral estradiol for vaginal use, it generally isn't recommended as there is little safety and efficacy data when they are used this way.

Since cost is an issue, vaginal tablets may be a good option for you. They are a lower strength than Estrace but are available generically and may be less expensive under your insurance. Generic estradiol tablets include:

  • Estradiol 10mcg (generic Vagifem)
  • Yuvafem 10mcg

Even though the tablets are a lower strength from Estrace cream, most studies show that they produce similar improvement in symptoms.

What Are The Options For Vaginal Estrogen?

I've made a chart below that details all of the vaginal estradiol options (including Premarin, which is a conjugated estrogen product):

Preparation
(United States Brand Name)
Available Strengths Recommended Regimen
Vaginal Ring
Estring 7.5 mcg estradiol daily, released over 90 days The ring is inserted into the vagina by the patient or clinician.
The ring is removed and replaced with a new ring every 90 days.
Vaginal Insert (Tablet)
Imvexxy 4 mcg estradiol per vaginal insert Insert 1 tablet intravaginally daily for 2 weeks, followed by twice weekly.
The dose may be increased to the 10 mcg insert according to clinical response.
Imvexxy,
Vagifem,
Yuvafem
10 mcg estradiol per vaginal insert Insert 1 tablet intravaginally daily for 2 weeks, followed by twice weekly.
Vaginal Cream
Premarin 0.625 mg conjugated estrogens per g of cream 0.5 g of cream intravaginally administered daily for 2 weeks, then reduce to twice weekly.
The dose may be adjusted according to the patient's symptoms and clinical response (range 0.5 to 2 g).
Estrace 100 mcg estradiol per g of cream 0.5 g of cream intravaginally administered daily for 2 weeks, then reduce to twice weekly.
The dose may be adjusted according to the patient's symptoms and clinical response (initial range: 0.5 to 4 g; maintenance range: 0.5 to 1 g).

Tablet Options For Estrace

As you can see in the table in the above section, the vaginal tablet options come in doses of 4mcg and 10mcg, far less than the 100mcg you get per gram of Estrace.

Now, it is important to note that vaginal estrogen tablets and vaginal cream can't be directly compared on a strength-strength basis as they each have different absorption profiles but studies do show the Estrace, when used at the usual dosages, does produce, generally, higher systemic concentrations of estrogen (i.e., estrogen in your blood) than the tablets do.

While most studies show that all vaginal estrogen products are fairly comparable in regard to how well they treat menopausal symptoms, I would expect some differences in how you respond to one product compared to another.

Since you mentioned oral estradiol, I'll say here that they come in doses of 0.5mg (500mcg), 1mg (1,000mcg), and 2mg (2,000mcg), clearly higher than what is available in the vaginal dosage forms.

I have seen some patients use oral estradiol tablets vaginally but it's not common. There is little data to go on regarding the safety of using the higher-strength oral tablets this way and little data regarding how well they work when used vaginally (i.e., they are not formulated for vaginal administration like the vaginal tablets are).

I think your safer options are to use the vaginal estradiol tablets (generic Vagifem or Yuvafem), but be sure to speak with your doctor about what options are best for you.

Estrace also is available generically, so that could be an option too.

Final Words

Thanks again for contacting us!

References

  • Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management, PubMed
  • Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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