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3. GSM Treatments

Therapies with local Vaginal (GSM) Benefit

Therapies with local Vaginal Benefit

Doses

Vaginal Estrogens

Vaginal Cream: Conjugated Equine Estrogen (PremarinⓇ)

0.5 – 1.0 gm nightly pv x 2 weeks then 2/week*

differs from product monograph

Vaginal Cream: Estrone (Estragyn®)

0.5 – 1.0 gm nightly pv x 2 weeks then 2/week*

differs from product monograph

Vaginal Tablet: 17B Estradiol (VagifemⓇ)

One tablet nightly pv x 2 weeks then 2/week

Vaginal Softgel Insert: 17B Estradiol (ImvexxyⓇ)

4 mcg or 10 mcg nightly pv x 2 weeks then 2/week

Vaginal Ring: 17B Estradiol (EstringⓇ)

Change ring q3 months

Vaginal DHEA

Vaginal Insert: Prasterone (IntrarosaⓇ)

6.5 mg pv daily

Oral agent for GSM

SERM: Ospemifene (OsphenaⓇ)

60 mg po daily

*Product monograph dosing is higher than as posted and could require endometrial protection.  Start with 0.5-1.0 gm nightly pv x 2 weeks then twice weekly.  At those doses endometrial protection should not be required however any unexplained vaginal bleeding should be investigated.

There are no studies at this time supporting the use of vaginal prasterone with systemic MHT.
Oral ospemifene cannot be combined with systemic MHT.

For a full listing of hormonal products and non-hormonal medication options click here

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