Need estrogen cream to help with menopausal dryness.

Can only see Premarin hereabouts (Chiang Mai). Premarin is manufactured in a way that is cruel to animals. There are, however, synthetic substitutes available. The problem is, how to get hold of them ? Is there a way to order online, perhaps ? Or via a doctor ?

Also, do any of you with experience using such creams find they do help ?

Could I take estrogen in a small dose orally instead ?

Any advice welcomed.

Not only cruel to horses, unnatural for the female human body.

What you need is 17 B estradiol in a topical preparation. Pills are not adviosable as they must pass thru the GI tract and liver, which is not how the human body normally handles estrogen. The closer you can come to what your body normally had the better.

If your only symptoms is vaginal dryness, no night sweats, hot flashes etc, and IF you can find it, there is a sustained release vaginal suppository form (brand name Vagifem) approved for use in Thailand.

If you can't find that, Oestrogel is widely available. It's a gel which contains some rubbing alcohol to aid evaporation once applied to the skin, for that reason should not be applied to the genitals (will sting if you do) but will work OK.

However unless you have had a hysterectomy, using Oestrogel or any other form of estrogen you need to also take progesterone for at least part of the month to avoid hyperplasia of the lining of the uterus and increased risk of uterine cancer. Problem is that the topical form of natural progestrone approved for use in Thailand, Progestogel (made by same French company that makes Oestrogel) is very hard to find these days. If you have occasion to travel to Cambodia it can easily be found in Phnom Penh. Otherwise you may have to settle for Utrogestan, which is also a natural progesterone but in oral form, which is not optimal for the same reasons as mentioned for estrogen...but better than nothing. Take at bedtime as it may cause some sleepiness.

Don't go near the synthetic progestins (Provera, Primulut etc) and don't listen to anyone, doctor or pharmacist included, who tries to tell you they are the "same"as progesterone. They aren't, and they have many unpleasant side effects.

general consesnsu seems to be that if you are using only a vaginal preparation you can forego the progesterone, but be careful to get yearly thin preps (pap smears).

If your only symptoms is vaginal dryness, no night sweats, hot flashes etc, and IF you can find it, there is a sustained release vaginal suppository form (brand name Vagifem) approved for use in Thailand.

The other symptoms do seem to have passed, on the whole - or perhaps I have got used to them - so that would seem the best option, do you think ?

If you can't find that, Oestrogel is widely available. It's a gel which contains some rubbing alcohol to aid evaporation once applied to the skin, for that reason should not be applied to the genitals (will sting if you do) but will work OK.

I have been using a progesterone cream called Endau which can be ordered online. (After much confusion about the best choice, I opted for the least intervention - just the Endau -but now the vaginal dryness is a problem).

I'll see what I can find and check back with you on the combination.

I don't trust many doctors on this issue, I'm afraid, and prefer the advice of other women who have done some investigation.

Thanks so much, Sheryl. This is extremely helpful.

Forgot to say - if there's any better option that I could order online, I'd be happy to do that.

And another question ...

Many of these hormonal products are "approved for short term use". One article defined this as 6 months to 5 years.

What happens after that ??

Usually by 5 years your body has adjusted.

However, use of vaginal cream only is pretty safe and if you need to use it indefinitely, so be it. Most of the absorption is local so effect on the endometrium (lining of the uterus) and systemic effects are not much. But of course should still get annual thin prep (pap smear). this is true even if not using hormones.

Yes, if your symptoms are only the vaghinal dryness then a vaginal preparation is best. If you cannot find the Vagifem in Thailand then mail order any brand of vagiunal suppository or cream that contains 17 B estradiol only. The main caution is that there are a fair amount of counterfeits on the mail order citcuit so choose supplier with care.

Thanks again, Sheryl. A big help.