Vaginal oestrogen (estrogen): creams, pessaries, Gina and safety after breast cancer

Vaginal oestrogen puts a small dose of oestrogen exactly where it's missing. It treats genitourinary syndrome of menopause (GSM, previously called vaginal atrophy). Here's what it comes as, where to get it, and who should check first.

Vaginal oestrogen cream, pessaries, tablets and rings

Vaginal oestrogen (estrogen) usually comes as oestradiol or oestriol (estriol). It's available as a cream, pessary, tablet, gel or ring. In the US, a pessary is called a suppository. Brand names you may see include Vagifem, Gina, Imvaggis and Ovesse. The British Menopause Society says today's low-dose products can be used for as long as you need them. You don't need to add a progestogen. You can also add vaginal oestrogen to HRT if dryness continues. Both the British Menopause Society and ESHRE recommend this.

Can I buy estriol cream over the counter?

Yes, since December 2024. Ovesse, an estriol cream, is now sold by pharmacies without a prescription. So is Gina, a small oestradiol vaginal tablet that you insert with an applicator. Some people call it a pessary. In the US, it would be a suppository. Gina has been available since 2022. It contains the same low dose of oestradiol as Vagifem, which is prescribed. Both Ovesse and Gina are for women aged 50 or over who haven't had a period for at least a year. A pharmacist will check this with you before selling them.

Is vaginal oestrogen safe after breast cancer?

Have you had breast cancer? Talk to your cancer team first. This matters most if you're taking an aromatase inhibitor. The British Menopause Society suggests trying non-hormonal options first. If they don't help, decide together with your cancer team.

If you can't use vaginal oestrogen

There are other options, including prasterone and ospemifene. See Vaginal dryness treatment: menopause, perimenopause, POI and after giving birth. Non-hormonal moisturisers help too. See How to relieve vaginal dryness: moisturisers, lubricants and what to avoid [add link when published].

References

British Menopause Society, "Genitourinary Syndrome of Menopause (GSM)," Consensus Statement (November 2025) https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/

MHRA, "Easier access to locally-applied HRT to treat postmenopausal vaginal symptoms in landmark MHRA reclassification," (July 2022) https://www.gov.uk/government/news/easier-access-to-locally-applied-hrt-to-treat-postmenopausal-vaginal-symptoms-in-landmark-mhra-reclassification

MIMS, "HRT vaginal cream now available without a prescription," (December 2024) https://www.mims.co.uk/hrt-vaginal-cream-available-without-prescription/womens-health/article/1898968

Women's Health Concern (British Menopause Society), "Vaginal dryness," Fact Sheet (October 2023) https://www.womens-health-concern.org/wp-content/uploads/2023/11/25-WHC-FACTSHEET-VaginalDryness-OCT2023-B.pdf

ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI, "Evidence-based guideline: premature ovarian insufficiency," Climacteric (December 2024) https://doi.org/10.1080/13697137.2024.2423213