vaginal HRT dosage and usage advice please

[Duck33]

hello there,

Just wondering if anyone can please give me some advice on vaginal HRT. Thanks in advance.

I was diagnosed with vaginal atrophy a couple of years ago - last period was three years ago - I’m 52. I was prescribed 10micrograms of Estradiol pessaries by GP a couple of years ago but I’ve never been brave enough to try it, but as dryness etc is becoming worse, and my YES moisturiser less effective, and my pessaries are still in date, I’m going to start using them.

I just wanted to check is 10micrograms a standard dose, or a high dose? I’ve read about low dose vaginal HRT and wondering if I should ask for a lower dose before starting. Maybe Blissel?

Also, is it okay to use Yes Yes vaginal moisturiser at the same time as the pessaries to make it less dry to insert. Or should I ask for a gel/cream instead.

Thanks so much for any advice. Really appreciate it.

[Me-non-pause]

Hi there,

This is what I know about it. I was - likes you- diagnosed with VA.

10 micrograms of estradiol (like Vagifem or its generic equivalent) is actually considered a low dose for vaginal HRT. It’s commonly prescribed to treat symptoms of vaginal atrophy (like dryness, itching, discomfort, and pain during sex). The typical dosing schedule is:

Initial phase: One pessary daily for 2 weeks

Maintenance phase: Twice a week (e.g., Monday & Thursday)

This dose delivers a small, localized amount of estrogen to the vaginal tissues, without significantly raising your systemic estrogen levels.

Blissel is a vaginal estriol gel, and yes, estriol is a milder form of estrogen than estradiol. It’s also a low-dose option, but since your pessaries are already a low dose, you may not need to switch unless you find the pessaries uncomfortable or ineffective. Blissel might be a good alternative if you prefer a gel.

Yes, you can absolutely keep using YES vaginal moisturiser alongside the pessaries! In fact, many women find it helpful to use a little bit of YES as a lubricant to make inserting the pessary more comfortable. Just avoid using it immediately after inserting the pessary so it doesn’t interfere with absorption — inserting the pessary at night before bed and using the moisturiser in the morning (or as needed during the day) is a good routine.

If insertion feels difficult, you could ask your GP about a vaginal estrogen cream (like Ovestin or Estriol cream) instead of pessaries, as cream can also act as a lubricant. But if you can manage with the pessaries (especially with a little YES gel), they’re super effective and easy to dose.

It’s normal to feel hesitant starting HRT, but vaginal estrogen is considered very safe for most people, even for long-term use. It works directly on the vaginal tissues, and systemic absorption is minimal — far less than standard HRT taken orally or via patch

All the best

[Duck33 in reply to Me-non-pause]

Hi Me-non-pause,

Thank you so much for taking the time and trouble to reply. I'm so grateful. Everything you've said is extremely useful.

It's definitely a bit daunting to give it a go...especially as it's been a few years since my last period, and hoping it won't cause bleeding etc. But from what I've read it seems positive. A friend said if taken long-term, it can also help prevent UTIs. Have you been on it for a while?

Thanks again for giving such a thorough reply. Really kind of you.

All the best

[ruth_p in reply to Me-non-pause]

Thank you for this information.

[Eevee_S]

hi there. I’ve been using vaginal estrogen for about 4 years now. The advice is not to even read the side effects paper inside the packaging as it is isn’t really meant for vaginal estrogen. It is such a low dose, and even with higher doses, it doesn’t go systemic. There’s been so much good press about all of this in the past year (are you in uk?). It is very very safe and absolutely essential for your health down there. It prevents all the nasties that are associated with the menopause - atrophy, urinary tract infections, incontinence. So please, start it as soon as possible and use daily. I use vagifem pessaries and also Ovestin for the outer tissues. All perfectly safe and life enhancing. If your atrophy is so bad, there’s also intrarosa which contains dhea and turns to estrogen and testosterone in the vagina and is, according to experts here, the best for reversing any atrophy. I can’t recommend it enough. It doesn’t go into your system, just replenishes the tissues. If also recommend the hrt too if you’re not already using. But that’s another topic. Hope you find it helpful.

[Duck33 in reply to Eevee_S]

Hi there,

thanks so much for replying! And also for the reassurance and encouragement. So kind of you. Must admit the leaflet in the box is what put me off trying it when I first got the prescription. Quite scary! It's been three years since my last period and the VA has definitely got worse in the last year, or so. Thought I'd missed the boat with trying it, as it's been a couple of years since my last period, and wasn't sure if it was still okay to start using it. But I feel enthusiastic to give it a go now. Really appreciate your help. Thank you so much. x

[Eevee_S in reply to Duck33]

Ahh you’re welcome. It is such a shame that people are frightened by all the info in the out of date guidance on any HRT. But particularly vaginal estrogen. Apparently, because it’s considered under the hrt umbrella, then they just put exactly the same warnings. And also, those warnings are based on the old fashioned hrt with synthetic hormones that women took in the past. It all needs updating so badly! So please, do not suffer any longer. Use it liberally, your body will thank you for it. And if you don’t feel it helps enough, then look into the intrarosa which is more potent to help things return to ‘normal’ down there. I hope you feel better soon. There’s a great website and app called Balance Menopause. If you’ve not heard of it, look it up. It’s fantastic and there’s a community on there to support each other. Take care x

[Duck33 in reply to Eevee_S]

Oh thanks so much! That's all great advice. I haven't come across Balance Menopause yet. I'll definitely check it out. Sounds so useful. Really feel empowered to sort things out now. Thanks again for all your brilliant encouragement. Have a lovely weekend. x