Estriol cream is a weak form of estrogen that is applied in the vagina to ease dryness and irritation from low estrogen, most often around menopause. It is a licensed prescription vaginal oestrogen in the UK and many other countries [1], but there is no FDA-approved estriol product in the U.S., so American women usually get it from a compounding pharmacy [7]. Here is what estriol is, what the research shows, how it compares with FDA-approved options, and the hormone-free alternatives. For the bigger picture, see our guide to vaginal dryness.
Key takeaways
- Estriol is a weaker estrogen, but it is still a hormone. Estriol cream is a prescription vaginal oestrogen in the UK and many other countries [1].
- In the U.S., no estriol product is FDA-approved. It is made by compounding pharmacies, and “estriol” creams sold online are not reviewed by the FDA [5][7].
- Vaginal estrogens, including estriol, ease dryness better than placebo, and no form has been shown to work better than another [2][3].
- FDA-approved choices include low-dose vaginal estradiol, conjugated estrogen cream, vaginal DHEA and ospemifene. For mild dryness, non-prescription moisturizers and lubricants are often enough [4].
By the numbers
- A 2016 Cochrane review pooled 30 randomized trials with 6,235 postmenopausal women. It found no difference in effectiveness between vaginal estrogen creams, tablets and rings, and estrogen cream helped symptoms more than placebo.
- In a phase III trial of 167 women, an ultra-low-dose estriol gel (50 micrograms per application) improved vaginal dryness more than placebo after 12 weeks.
- The NHS says vaginal oestrogen can take up to 3 months to work fully.
What is estriol cream?
Estriol cream is a vaginal estrogen cream that contains estriol, one of the estrogens the body makes naturally. Estriol has weaker estrogen activity than estradiol, the main estrogen before menopause, and the body clears it quickly [7].
Like other vaginal estrogens, it is used to treat the dryness and irritation that come with lower estrogen levels. The NHS lists estriol vaginal cream among its vaginal oestrogen brands and notes that vaginal oestrogen does not treat hot flushes, mood swings or sleep problems [1]. When dryness comes with soreness, urinary symptoms or pain during sex after menopause, doctors call it genitourinary syndrome of menopause (GSM).
Does estriol cream work for vaginal dryness?
Yes, the research suggests that licensed estriol products ease vaginal dryness, much like other vaginal estrogens. In a double-blind phase III trial, 167 postmenopausal women used either a 0.005% estriol gel or a placebo gel daily for 3 weeks, then twice a week up to 12 weeks. The estriol group had greater improvement in vaginal dryness and lower vaginal pH, and side effects were similar in both groups [3].
Looking at vaginal estrogen as a group, a Cochrane review of 30 trials found low-quality evidence that creams, tablets and rings all improve symptoms compared with placebo, with no clear winner between them [2]. The NHS says it can take up to 3 months to work fully, and that common early side effects such as headache, abdominal or vaginal pain and bleeding usually settle in the first few months [1].
Important: these results come from licensed, tested products. They do not tell you whether a compounded or online estriol cream contains the dose it says.
Is estriol cream FDA-approved?
No. Estriol is not approved for use in the U.S. or Canada, although compounding pharmacies make it as part of “bioidentical” hormone therapy [7]. Compounded products are custom mixed and are not held to the same quality standards as FDA-approved drugs, so the dose and purity can vary from batch to batch, according to Mayo Clinic [6].
At the FDA’s request, the National Academies of Sciences, Engineering, and Medicine reviewed compounded bioidentical hormones in 2020. It found a lack of rigorous evidence for their safety and effectiveness, limited oversight of their quality, and concluded that their widespread use is a public health concern [5].
Is there a non-prescription estrogen cream?
Not in the U.S. There is no FDA-approved over-the-counter estrogen cream, and topical creams sold online that say they contain estriol are not regulated as drugs [7]. You can’t be sure how much hormone, if any, they contain.
In the UK the rules are different: the NHS says vaginal oestrogen is prescription-only except two brands, Gina vaginal tablets and Ovesse vaginal cream, which you can buy from a pharmacy [1]. If you are in the U.S. and want a hormone-free product you can buy without a prescription, look at vaginal moisturizers and lubricants instead.
Estriol vs. estradiol and other options
In the U.S., FDA-approved vaginal estradiol and other prescription treatments are the better-studied alternatives to compounded estriol. This table compares the main choices.
| Option | Hormone? | U.S. status | Good to know |
|---|---|---|---|
| Estriol cream (compounded) | Yes, estrogen | Not FDA-approved; made by compounding pharmacies | Dose and purity can vary between batches [6] |
| Low-dose vaginal estradiol (cream, insert or ring) | Yes, estrogen | FDA-approved, prescription | Low-dose vaginal estrogens are effective for moderate to severe GSM [4]. See Vagifem alternatives |
| Conjugated estrogen cream (Premarin) | Yes, estrogen | FDA-approved, prescription | See Premarin cream alternatives |
| Vaginal DHEA (prasterone) insert | Hormone precursor | FDA-approved, prescription | Nightly insert. See DHEA for vaginal dryness |
| Ospemifene (Osphena) | No, non-estrogen pill that acts on estrogen receptors | FDA-approved, prescription | Daily pill. See ospemifene |
| Vaginal moisturizer and lubricant | No | Over the counter | Often enough for mild dryness [4] |
Is estriol safer than estradiol?
There is no good evidence that estriol is safer. It is often marketed as a “natural” or gentler estrogen, but Mayo Clinic says hormones sold as bioidentical or natural are not safer than standard hormone therapy and have not been shown to work better for symptoms such as vaginal dryness [6]. Many FDA-approved products already contain bioidentical estradiol [6].
The Menopause Society notes that with low-dose vaginal estrogen a progestogen is not needed, although endometrial safety has not been studied in trials beyond a year [4]. If you have had breast cancer or another hormone-sensitive condition, talk with your oncologist before using any estrogen. See vaginal dryness after breast cancer. For a side-by-side look at hormonal and hormone-free care, read vaginal estrogen vs. hormone-free options.
Hormone-free alternatives to estriol cream
For mild dryness, non-prescription, hormone-free products give enough relief for most women, according to The Menopause Society [4]. These are the usual first steps:
- A vaginal moisturizer used every 2 to 3 days for everyday comfort, even on days you are not intimate. Many contain hyaluronic acid.
- A lubricant during sex to reduce friction right away. See moisturizer vs. lubricant.
- Gentle care: skip scented soaps, wipes and douches.
- Pelvic floor physical therapy if sex is painful or the muscles feel tight.
- Be wary of “natural” hormone creams. Herbal or “bioidentical” products sold online can still contain hormones, and their contents are not checked. See natural remedies for vaginal dryness for what has evidence behind it.
If these aren’t enough, see non-hormonal treatment for vaginal dryness and our overview of how to treat vaginal dryness.
Looking for hormone-free everyday comfort?
If you want a hormone-free addition to your comfort routine, AIRS Advanced Intimate Renewal Serum is a cosmetic serum with hyaluronic acid in single-use applicators that helps moisturize and soothe delicate intimate skin. It is not a substitute for a prescribed medicine, so talk with your clinician about combining it with any treatment. Choose 1 box, subscribe & save 10%, or the 90-Day Regimen (3 boxes, $150/box, free shipping).
When to see a doctor
See a clinician before starting any estrogen product, including estriol, and if dryness lasts more than a few weeks despite a moisturizer and lubricant. Get checked promptly if you have any bleeding after menopause, pain that is getting worse, unusual discharge or odor, or burning when you pee. If you are not sure where to start, our resources page lists ways to find a menopause specialist, and how to talk to your doctor has questions to bring.
Frequently asked questions
What is estriol cream used for?
Estriol cream is a vaginal estrogen used to ease vaginal dryness and irritation caused by low estrogen around menopause. In the UK it is a prescription vaginal oestrogen. In the U.S. there is no FDA-approved estriol product, so it is usually made by compounding pharmacies.
Is estriol cream available over the counter?
In the U.S., there is no FDA-approved over-the-counter estrogen cream. Creams sold online that say they contain estriol are not reviewed by the FDA, so the dose and quality are unknown. In the UK, one vaginal oestrogen cream (Ovesse) and one vaginal tablet (Gina) can be bought from a pharmacy.
Is estriol safer than estradiol?
There is no good evidence that it is. Estriol is a weaker estrogen, but a National Academies review found too little high-quality evidence that compounded bioidentical hormones are safe and effective, and Mayo Clinic says they are not safer than approved hormone therapy. FDA-approved low-dose vaginal estradiol is the better-studied option in the U.S.
How long does estriol cream take to work?
The NHS says vaginal oestrogen can take up to 3 months to work fully. In one trial of an ultra-low-dose estriol gel, most symptoms had improved more than with placebo by week 3, and vaginal dryness had improved more by week 12.
What can I use instead of estriol cream?
Ask your clinician about FDA-approved options such as low-dose vaginal estradiol creams, inserts or rings, conjugated estrogen cream, vaginal DHEA or ospemifene. For mild dryness, a vaginal moisturizer used every few days and a lubricant during sex are often enough.
Related reading
- How to treat vaginal dryness: options compared
- Non-hormonal treatment for vaginal dryness
- Alternatives to Premarin vaginal cream
- Alternatives to Vagifem
- Vaginal estrogen vs. hormone-free options
- Menopause and GSM
Sources
- NHS. About vaginal oestrogen.
- Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016.
- Cano A, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy. Menopause. 2012.
- The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement. Menopause. 2020;27(9):976–992.
- U.S. Food and Drug Administration. NASEM study on the clinical utility of treating patients with compounded “bioidentical” hormone therapy.
- Mayo Clinic. Bioidentical hormones: Are they safer?
- Wikipedia. Estriol (medication) (background on availability and regulation).
