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Table 8. Classification of Government-Approved Vaginal
Estrogens
Type Dose
Serum Estradiol
Level
Low dose <20 pg/mL
Silastic estradiol vaginal ring 7.5 µg
Estradiol vaginal tablet 10 µg
Promestriene (estradiol diether) ovule
a
10 mg
Estriol ovule
a
0.5 mg
Estriol + progesterone +
Lactobacillus doderleini ovule
a
0.2 mg + 2 mg +
341 mg
Promestriene cream
a
3 mg
Estriol cream
a
0.015– 0.03 mg
Intermediate dose >20 pg/mL
CEE vaginal cream >0.3-mg dose 5–50 pg/mL
Estradiol vaginal tablet 25 µg
b
Some >20 pg/mL
High dose (systemic) 35–200 pg/mL
Estradiol vaginal ring 50 and 100 µg
Vaginal estradiol >0.5 mg
Vaginal CEE
>0.5 mg
c
a
Not approved or recommended in United States.
b
No longer available in United States.
c
Predominantly estrone sulfate. LH suppression reflects systemic absorption.
Ospemifene
Î For treatment of moderate to severe dyspareunia associated with
vaginal atrophy in postmenopausal women without contraindications,
we suggest a trial of ospemifene. (2|⊕⊕⊕
)
Î For women with a history of breast cancer presenting with
dyspareunia, we recommend against ospemifene. (1|⊕
)
