Congratulations!

Your prescription for low-dose vaginal estrogen will be sent to the pharmacy you selected in the next 3-5 business days. We’re glad you chose About Time to help make getting the treatment you need a little easier.

Here are a few things to know as you get started.

How to use your vaginal estrogen

Please follow the dosing instructions on your prescription. Your dosing was chosen as a low dose option which does not require progesterone use. I do not recommend starting with daily use in the first two weeks. To make things easy, just start your prescription by using it twice a week.

If you were prescribed vaginal estrogen cream:

You may use the applicator provided with the medication, but you do not have to. If the applicator is uncomfortable or inconvenient, you can place the prescribed amount of cream into the vagina using a clean finger. The cream can also be gently applied around the vaginal opening and labia tissues if this is where you are experiencing dryness, burning, or irritation.

If you were prescribed a vaginal estrogen tablet or insert:

You may use the applicator provided with your medication. If inserting the applicator is uncomfortable, many vaginal tablets or inserts can also be gently placed into the vagina with a clean finger. It does not need to be pushed deeply into the vagina to be effective.

Using vaginal estrogen at bedtime can be convenient and may decrease leakage. With cream in particular, a small amount of discharge or leakage afterward is normal. A panty liner can be helpful if needed.

When should I expect to feel better?

Vaginal estrogen works by gradually restoring estrogen to the vaginal and urinary tissues. Some women notice improvement within a few weeks, but it may take 6–12 weeks to experience the full benefit, particularly for urinary symptoms and prevention of recurrent urinary tract infections.

Consistency is important. Vaginal estrogen is generally a long-term treatment rather than a short course of medication. If you stop using it, symptoms will gradually return.

Possible side effects

Low-dose vaginal estrogen is usually very well tolerated. Some women notice temporary vaginal irritation, itching, increased discharge, or spotting after starting treatment. This will improve with time.

A vaginal yeast infection can also occur. When you first start vaginal estrogen, the vaginal tissues begin to become healthier and produce more glycogen, a natural sugar stored in the cells of the vagina.

This is actually a good and expected effect of estrogen. Glycogen helps support healthy vaginal bacteria, particularly Lactobacillus, which help maintain the vagina’s naturally acidic environment and protect against many types of infection.

However, yeast can also use these sugars as a food source. As the vaginal environment changes after starting estrogen, some women may temporarily be more likely to develop a yeast infection.

Symptoms can include itching, burning, redness, or a thick white discharge.

Developing a yeast infection does not mean that you are allergic to vaginal estrogen or that the medication is harming your vagina. In most cases, the yeast infection can be treated while vaginal estrogen is continued. The longer you use the vaginal estrogen, the lower the risk of yeast infections.

Over time, estrogen generally helps restore a healthier vaginal environment and supports the normal bacteria that protect the vagina.

A few other things to know

Low-dose vaginal estrogen is different from systemic hormone therapy such as estrogen pills, patches, gels, or sprays. It delivers a small amount of estrogen directly to the vaginal and surrounding urinary tissues, with very little entering the bloodstream.

You can continue to use vaginal moisturizers and lubricants while using vaginal estrogen if you need additional relief from dryness or discomfort with sexual activity.

If you miss a dose, simply use it when you remember unless you are close to your next scheduled dose. There is no need to double your dose.

And remember—there is no need to suffer through vaginal or urinary symptoms caused by low estrogen. These symptoms are common, treatable, and deserving of care.

Thank you for trusting About Time with your care.

Warmly,

Kerrie Adams, MD, MCR

Founder, About Time