How to Apply Estradiol Cream With Your Finger (Plus 5 More Pharmacist-Backed Tips for Using It)

GoodRx Health

From hot flashes to vaginal dryness, the body undergoes a lot of changes during menopause. These changes are due to a drop in the levels of two hormones - estrogen and progesterone. Fortunately, hormone replacement therapy (HRT) can help manage many menopausal symptoms.

Estradiol vaginal cream (Estrace) is one type of HRT. It helps treat vulvar and vaginal dryness and painful sex caused by menopause. Estradiol vaginal cream may also help with urinary urgency and frequency, which reduces the risk of urinary tract infections.

But what's the best way to apply estradiol vaginal cream? Do you need to use the applicator, or can you just use your finger? Here, we'll cover six tips for using estradiol vaginal cream to help you get the most from your medication.

1. It's best to use the included applicator to measure your vaginal estradiol dose

Vaginal estradiol cream comes with a reusable applicator to help you measure and insert your dose. Here are the steps for using it:

• Press the plunger end of the applicator all the way down.

• Screw the open end of the applicator onto the open end of your tube of vaginal cream.

• Gently squeeze the tube so the cream fills the applicator.

• The plunger has lines marking 1 g to 4 g of cream. Stop squeezing when it reaches the line for your recommended dose.

• Unscrew the applicator from the tube of vaginal cream and put the cap back on the tube.

• Insert the applicator into the vagina as far as is comfortable and press down on the plunger.

• Remove the applicator and wash it with soap and warm water.

Using the applicator helps ensure you're measuring the correct dose of estradiol cream. It also helps reduce the risk of contamination, since the cream goes directly from the tube into the applicator.

2. Your prescriber may recommend applying estradiol cream with your finger - here's how to do it

Using a finger to apply the cream may be appropriate in some cases, according to Dr. Stephanie Faubion, Director of the Mayo Clinic Center for Women's Health and Medical Director for The Menopause Society.

"I often recommend that women simply use their finger to apply the estrogen cream…because the applicator can sometimes be challenging to use and may cause discomfort for some women with more severe symptoms," said Faubion.

To do this, Faubion suggests measuring your dose using the applicator. Then, squeeze the cream from the applicator onto a finger. This helps you to see how much cream is needed for each dose. You can then use your finger to insert the cream inside your vagina. Faubion also recommends applying a small amount of cream to the vulva (external genital area) as well, since dryness symptoms can affect this area too. Be sure to wash your hands with soap and water before and after using this method.

If you're having trouble or discomfort using the applicator, talk to your prescriber about using the finger method instead.

3. It's normal to experience some leakage after inserting vaginal estradiol cream

You may notice some leakage after inserting estradiol vaginal cream. This is normal, and shouldn't affect how well the medication works.

Lying down for a few minutes after administering your dose or inserting it at bedtime may help reduce leakage. Don't use a tampon or other vaginal products to try to keep the cream in place. But it's a good idea to wear a sanitary pad or pantyliner to protect your clothing.

4. Vaginal estradiol cream may not work right away

It can take time for vaginal estradiol cream to start working. "Women won't have the full effect of the vaginal estrogen cream for 2 to 3 months," said Faubian. "Also, it must be used long-term because the symptoms will recur when it is discontinued."

In the meantime, Faubion recommends that to alleviate dryness and discomfort, "women can and should still use a lubricant as needed for sexual activity."

5. You can use vaginal estradiol cream with other forms of estrogen

The estrogen in vaginal estradiol cream mainly works in the area where it's applied. It isn't well-absorbed into the bloodstream. So it won't help with full-body menopause symptoms, like hot flashes and night sweats. These symptoms require treatment with estrogen that's absorbed into the bloodstream (systemic forms of estrogen). This includes oral tablets and topical patches or gels.

In some cases, you may need a combination of vaginal and systemic estrogen to manage your symptoms. Faubion confirms, "Yes, you can use low-dose vaginal estrogen cream in addition to systemic estrogen (such as a pill, patch, gel or spray), and sometimes it is necessary to adequately address the genitourinary symptoms. For some women, and especially those who are using lower systemic doses, the systemic estrogen is insufficient to manage the genitourinary symptoms."

Keep in mind that there are different risks with systemic estrogen treatments than with estradiol vaginal cream. And if you have a uterus, you'll need to take a progestin along with a systemic estrogen. Be sure to discuss the risks and benefits of the different types of HRT with your prescriber.

6. Some side effects are possible with vaginal estradiol cream

Most estradiol vaginal cream side effects are related to the area where you apply it. This includes:

• Vaginal discharge

• Vaginal bleeding

• Vaginal burning or irritation

• Yeast infections

Faubion explains that "Low-dose vaginal estrogen is minimally absorbed and has not been linked with adverse events such as blood clot, heart attack or breast cancer." However, she says rarely, some people notice breast pain when they start using the cream. She also recommends that if vaginal bleeding occurs, you should contact your prescriber. Vaginal bleeding after menopause could be linked to a serious health problem and should be evaluated.

Tips for saving on estradiol cream

Estradiol vaginal cream (Estrace) is available as both a brand-name medication and a lower-cost generic. Generic estradiol cream's price at certain pharmacies is as low as $26.05per tube with a free GoodRx discount.

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