OVESTIN

Ovestin is a prescription vaginal medicine containing estriol, a natural female oestrogen. It is used in postmenopausal women to relieve vaginal symptoms caused by reduced oestrogen levels.

Ovestin is available as a 1 mg/g vaginal cream and as 0.5 mg vaginal pessaries. Both formulations are intended for local vaginal use.

Ovestin – formulations, use, dosage and precautions

What is Ovestin used for?

Ovestin is used in women who have been postmenopausal for at least 12 months for:

• treatment of vaginal atrophy caused by oestrogen deficiency;
• relief of vaginal dryness, irritation, itching and discomfort;
• relief of painful intercourse associated with vaginal atrophy;
• preoperative and postoperative treatment of postmenopausal women undergoing vaginal surgery.

Oestrogen deficiency may make the vaginal wall thinner and drier and may alter the normal vaginal flora and pH. Urinary urgency, mild urinary incontinence or recurrent bladder inflammation may also occur.

Vaginal estriol helps restore the urogenital epithelium, normal microflora and physiological vaginal pH. Improvement may take several days or several weeks.

How is Ovestin vaginal cream used?

The cream is administered with the calibrated applicator, preferably in the evening before going to bed.

One applicator dose filled to the ring mark contains 0.5 g of cream, corresponding to 0.5 mg of estriol.

• Vaginal atrophy: one applicator dose daily during the first weeks, for no longer than four weeks, followed by gradual reduction to a maintenance dose such as one application twice weekly.
• Before vaginal surgery: one dose daily for two weeks before surgery.
• After vaginal surgery: one dose twice weekly for two weeks after surgery.

Clean the applicator according to the supplied instructions. Do not use boiling water or an aggressive cleaning agent.

How are Ovestin pessaries used?

Insert one pessary deeply into the vagina, preferably in the evening before bedtime.

• Vaginal atrophy: one pessary daily during the first weeks, for a maximum of four weeks, followed by gradual reduction to a maintenance dose such as one pessary twice weekly.
• Before vaginal surgery: one pessary daily for two weeks.
• After vaginal surgery: one pessary twice weekly for two weeks.

The lowest effective dose should be used for the shortest period required to control symptoms.

Missed dose

Apply the missed dose when remembered unless the next scheduled dose is due that day. In that case, skip the missed dose.

Do not use two doses of cream or two pessaries on the same day.

Who must not use Ovestin?

• patients allergic to estriol or another ingredient;
• patients with known, previous or suspected breast cancer;
• patients with a known or suspected oestrogen-dependent tumour;
• patients with unexplained genital bleeding;
• patients with untreated endometrial hyperplasia;
• patients with previous or current deep-vein thrombosis or pulmonary embolism;
• patients with a known thrombophilic disorder;
• patients with active or recent arterial thromboembolic disease;
• patients with acute liver disease or a history of liver disease until liver function has normalised;
• patients with porphyria.

Conditions requiring additional monitoring

Tell the doctor about fibroids, endometriosis, previous endometrial hyperplasia, hypertension, migraine, epilepsy, asthma, diabetes, liver or gallbladder disease, systemic lupus erythematosus, raised triglycerides, heart or kidney disease and risk factors for blood clots or oestrogen-dependent cancer.

The benefits and risks of continued treatment should be reviewed at least once a year.

Vaginal bleeding and the endometrium

Minor spotting may occur, particularly at the beginning of treatment. New, recurrent or persistent bleeding requires gynaecological assessment.

Do not exceed the maximum daily dose or continue daily treatment for longer than four weeks. Routine addition of a progestogen is not recommended with the low maintenance dose used twice weekly.

Interactions

Clinically important interactions are less likely because Ovestin is administered vaginally and systemic absorption is low. Nevertheless, tell the doctor about all medicines, herbal products and other vaginal treatments.

Particular caution may be required with anticonvulsants, rifampicin, rifabutin, nevirapine, efavirenz, ritonavir, nelfinavir, St John’s wort and certain hepatitis C combinations.

Do not independently combine Ovestin with vaginal probiotics, antiseptics, antifungal products, moisturising gels or other pessaries without checking the appropriate interval between applications.

Pregnancy, breastfeeding and contraception

Ovestin is intended for postmenopausal women and is not indicated during pregnancy or breastfeeding.

Stop treatment and contact the doctor if pregnancy occurs. Ovestin is not a contraceptive.

Possible side effects

• breast tenderness, discomfort or pain;
• minor vaginal bleeding or spotting;
• increased vaginal discharge;
• local irritation, itching or burning;
• nausea;
• fluid retention and swollen ankles or feet;
• flu-like symptoms.

These effects are commonly temporary and may improve during the first weeks. They may also indicate that the dose is too high.

Surgery

Tell the surgeon that Ovestin is being used. Depending on the procedure, the risk of thrombosis and the expected period of immobility, treatment may need to be stopped four to six weeks before surgery.

Availability and price

Related care and education

Additional non-hormonal products for menopause and intimate comfort are available in the Women’s Health, Menopause and PMS category.

Vaginal moisturisers, hyaluronic-acid pessaries and lubricants do not replace Ovestin when local estriol therapy has been prescribed.

Related blog topic: How to increase female libido – vaginal dryness, hormones and intimate comfort

Composition and storage

Vaginal cream: each gram contains 1 mg estriol. Store below 25°C and do not freeze. Cetyl alcohol and stearyl alcohol may cause local skin reactions.

Pessaries: each pessary contains 0.5 mg estriol in a solid-fat base. Store between 2°C and 25°C in the original packaging to protect from light and moisture.

Marketing authorisation holder: Clinres Farmacija d.o.o. Belgrade.
Cream manufacturer: Aspen Bad Oldesloe GmbH, Germany.
Pessary manufacturer: Unither Industries, France.

Frequently asked questions

Official sources: ALIMS – Ovestin vaginal cream leaflet | ALIMS – vaginal cream SmPC | ALIMS – Ovestin pessary documentation.
Vaginal cream authorisation renewed on 4 April 2024. Pessary authorisation renewed on 29 April 2024. Content checked: July 2026.