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Estriol 30 microgram pessary


Pessary containing estriol.

Drugs List

  • estriol 30microgram pessary
  • IMVAGGIS 30microgram pessary
  • Therapeutic Indications


    Local treatment for vaginal symptoms of oestrogen deficiency:postmenopausal

    Local treatment of vaginal symptoms of oestrogen deficiency in postmenopausal women.



    Insert one pessary in the evening before bed, for three weeks.

    Thereafter, insert one pessary twice a week in the evening before bed.

    Continued treatment should be on the lowest effective dose for the shortest period.

    Additional Dosage Information

    Missed pessary insertion
    During daily use within the first three weeks:
    If a missed dose is not realised before the following day, it should not be replaced. Resume normal dose schedule.

    During twice weekly use:
    A missed dose should be administered as soon as possible.


    Abnormal liver function test
    Acute hepatic disorder
    Breast cancer
    Deep vein thrombosis
    History of breast cancer
    History of thromboembolic disorder
    Hormone dependent neoplasm
    Myocardial infarction
    Pulmonary embolism
    Thromboembolic disorder
    Thrombophilic disorder
    Uncontrolled endometrial hyperplasia
    Undiagnosed gynaecological haemorrhage

    Precautions and Warnings

    Predisposition to thromboembolic disease
    Prolonged immobilisation
    Recent surgery
    Severe headache
    Cardiac impairment
    Diabetes mellitus
    Endometrial hyperplasia
    Epileptic disorder
    Hepatic adenoma
    Hepatic disorder
    Renal impairment
    Uterine fibroids

    Assess family medical history prior to commencing treatment
    Exclude breast cancer before treatment
    Exclude oestrogen dependent neoplasm before treatment
    Treat vaginal infections before initiation of therapy
    Do breast & pelvic exam. before & during treatment if clinically indicated
    Exclude pregnancy prior to initiation of treatment
    Abnormal and/or irregular bleeding should be investigated
    Advise patients of risks/benefits & review need for treatment regularly
    Monitor hepatic function in patients with history of hepatic disease
    Advise patient of thromboembolic symptoms and to report them if they occur
    Advise patient that changes in their breasts should be reported to Dr/nurse
    Avoid immobilisation-treatment may cause increased risk of thromboembolism
    Uterine fibroids may increase in size
    Discontinue 4 - 6 weeks before major surgery
    Advise patient to seek advice at first indications of pregnancy
    Discontinue at first signs of thrombophlebitis or thromboembolism
    Discontinue if cholestasis develops
    Discontinue if first occurrence or worsening of migraine/severe headache
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if pre-existing uterine fibroids increase in size
    Discontinue if significant rise in blood pressure occurs
    Discontinue if sudden pain in the chest occurs
    Discontinue if symptoms due to endometriosis are exacerbated
    Female: Not for contraception.Use non-hormonal contraception, if required
    Male & female: Damages latex condoms and diaphragms

    Hormone replacement therapy (HRT) should only be considered for patients whose symptoms adversely affect quality of life. An annual careful appraisal of the risks and benefits should be undertaken. When carrying out initial medical examinations of patients, ensure that investigations (including appropriate imaging tools, e.g. mammography) are carried out in accordance with currently accepted screening practices.

    For the treatment of menopausal symptoms the benefits of short-term HRT are considered to outweigh the risks in the majority of women.
    In all cases, it is good practice to use the lowest effective dose for the shortest possible time and to review the need to continue treatment at least annually.

    Physical examination should be guided by this and a knowledge of the contraindications and precautions and warnings for use of the product. Investigations including mammography should be carried out in accordance with currently accepted screening practices, modified according to the clinical needs of the individual.

    There is an increased risk of breast cancer in women currently or recently using systemic Hormone Replacement Therapy (HRT). The risk of breast cancer increases with the duration of treatment and returns to normal after 5 years of stopping treatment. This risk applies to a lesser extent for vaginal application.

    Treatment with vaginal estriol has not been attributed to an increased risk of endometrial hyperplasia or uterine cancer. Oestrogen products for vaginal application where the oestrogen exposure is low should not be given with progestagen. The saftey of long term or repeated use of vaginally administered oestrogen on the endometrium is uncertain. Examinations to rule out endometrial abnormalities should be undertaken at regular intervals.

    Pregnancy and Lactation


    Estriol pessaries are contraindicated during pregnancy.

    Should pregnancy occur, treatment should be discontinued immediately.

    At the time of writing there is limited published information regarding the use of vaginally applied estriol during pregnancy. Potential risks are unknown. The manufacturer suggests current studies indicate no teratogenic or fetotoxic effects in the event of inadvertent exposure.


    Estriol pessaries are contraindicated during breastfeeding.

    The manufacturer advises very low doses of vaginally applied estriol are unlikely to affect lactation.


    Advise patient of the increased risk of breast cancer vs benefits of HRT.
    Advise patient that changes in their breasts should be reported to Dr/nurse.
    Encourage patients to participate in the national breast cancer screening programme and the national cervical cancer screening programme as appropriate for their age. Breast awareness should also be encouraged and patients advised to report any changes in their breasts to their doctor or nurse.
    Advise women of child bearing potential that HRT does not provide contraceptive cover and non-hormonal contraception should be used during treatment.
    Advise patient to seek advise at first indications of pregnancy
    Advise patient to discontinue therapy if abnormal neurological signs develop.
    Advise patient of thromboembolic symptoms and to report them if they occur (e.g. painful swelling of a leg, sudden pain in the chest, dyspnoea).

    Side Effects

    Irritation (localised)
    Local pain
    Rectal discomfort
    Vaginal discharge
    Vulvovaginal burning


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Updated: September 2019

    Reference Sources

    Summary of Product Characteristics: Imvaggis 0.03mg pessary. Besins Healthcare Ltd. Revised November 2018.

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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