These are the latest guidelines from the Position statement for management of GSM (Vaginal Atrophy) Dr Louise Newson and referenced by many others in their field. NICE guidelines due to be updated in November which will hopefully include appropriate treatment doses for GSM.
"Women should also be advised that the information packaged with vaginal hormone preparations is out of date and factually incorrect. This needs to be changed by the MHRA.
The dose of vaginal oestrogen is very low, for example, using 10mcg oestrogen pessaries regularly for one year is an equivalent dose to just one 1mg of oestradiol HRT tablet.
If symptoms do not improve with vaginal oestrogen, consider increasing the dose, changing preparation (and consider DHEA) or using an additional treatment such as systemic HRT or two local treatments.
The frequency of using these preparations can be increased in women who have persistent symptoms as the doses of these preparations are very low.
Vaginal oestrogens can often improve urinary symptoms, including urinary infections.
Some women use vaginal oestrogen preparations more frequently than the recommended dose to improve symptoms sufficiently, for example Vagifem alternate days instead of twice a week. It is safe to use the treatment in this way as the dose is very low.
Women should be reassured that it is safe for topical oestrogen to continue in the long term (medication should be on a repeat prescription). Women should continue to be reassured about the long- term safety of vaginal oestrogen preparations."
