Ask the Nurse

I am a postmenopausal woman, weaning myself off of systemic topical estrogen. My gynecologist recommended Osphena®, but said I should wait one month before using, and the package said it could be months before I notice a difference! Also, there are all kinds of warnings regarding blood clots. Really? Wouldn't an estrogen cream be safer, effective and faster?

Ospemifene/Osphena® 60mg daily with food is a newer designer, oral NON-estrogen treatment. It acts as on some estrogen receptors in the vagina just as estrogen does, but not on all estrogen receptors and it is NOT an estrogen.

Ospemifene/Osphena® was FDA approved for the treatment of moderate to severe dyspareunia and vaginal dryness in postmenopausal women. It is the one non-estrogen oral option, which is nice for women who don’t want to insert vaginal products. Osphena® is like other estrogen agonist/antagonists tamoxifen/Nolvodex®, raloxifene/Evista® as well as the “designer estrogen” Conjugated estrogens/Bazedoxefine/Duavee® as well as other systemic oral estrogen menopausal therapy and hormonal contraceptives in that all of these agents-either estrogen agonist/antagonists as well as systemic oral estrogen can increase the risk of blood clot. Please avoid these agents if you have had deep vein blood clots or are on bed rest.

Certainly, local estrogen like Estrace® vaginal cream, Premarin® vaginal cream, estradiol ring/Estring® estradiol tablets or inserts like Imvexxy® can be used locally as well as local non-estrogens like vaginal DHEA/Intrarosa® to treat genito-urinary syndrome of menopause.

Local vaginal estrogens do NOT have the same risks as systemic oral estrogen nor do they have the same benefits either. If you have had a hysterectomy, staying on the systemic estrogen gel (Estrogel®, Elestrin®, Divigel® or estradiol patches) you were using may still be the best option pending bone density and menopausal symptoms.

All My Best,
Speaking of Women’s Health Nurse

January 16, 2019 at 10:32am