(17b Estradiol) (A prescription - to be used topically)
*Note this is used on 'top' of the vulvar tissue, not inside the vagina.
Estrace is the 'name brand' of a female estrogen cream (17b Estradiol). To be used topically for restoration of tissue to give it back it's elastin and collagen - its stretch ability, its 'give', its tone, color, resiliency, elasticity, plumpness and overall healthiness, and hopefully for 'unfusing' the adhesions that may go along with LS and restoring the architecture of the vulva.
It completely unfused me after three solid years of being like that out of the ten I had that severe pain and even if it doesn't, (If one has true atrophy) it will definitely make that tissue healthier. The steroids won't do that! Estrogen (17b estradiol) or E2, is known to have many wound healing benefits for the skin - not only for the genitals - and is considered an anti-inflammatory agent as well, by virtue of healing that tissue. Plus estrogen helps the nerve endings so they feel less pain. The medical community knows this and that's why an estrogen used topically or intravaginally is so often suggested for menopausal women to restore that genital tissue. It's definitely been found in the medical literature used topically to unfuse labial adhesions in children, but apparently no studies with adults - assuming it won't work, and it certainly can and does!! I'm living proof and many others (hundreds of testimonies) on our groups have as well.
Check out just a handful of the testimonies I've put in the File section of our Home page. Also for information you may want to check out this link....
It talks about how 50% of the women with 'Vestibulitis' in a study did not express 'any' Estrogen 'receptors'. It's the 'receptors' that are the active and working part of our cells like keys that open locked doors. Often those receptors can be blocked by things such as progestin/progesterone, phytoestrogens, soy, yeast, and esp. birth control pills.
For another good article about how BC's (birth control *contraceptives*) particularly those high in progestin may affect vulvar pain with vestibulitis, check out this article from the American Journal of Epidemiology.
Use of Oral Contraceptive Pills and Vulvar Vestibulitis: A Case-Control Study
I believe a big part of that is because progestins in birth control 'block' those estrogen receptors. That is also why often in a test, the blood serum levels of estrogen may be fine and normal so a physician may be reluctant to give you estrogen (Estrace) especially if you are younger, stating your E levels are fine, but it does not necessarily mean the E. 'Receptors' are receiving it, they may be defunct or deficient. They are two totally separate and distinct things, and why using the estrogen even topically can work so well as it fills those receptors from an external source.
However, topical estrogen may not work for everyone, especially if it's true atrophy - but in many it has. I've seen physicians make mistakes and diagnose atrophy when it wasn't, but it was truly the fusing or adhesions of LS. To understand the differences between fusing and atrophy, click here for an article I wrote on the subject: Fusing vs Atrophy.
But keep this in mind: Estrace cream is 'not' used for its soothing qualities perse, nor to be used in a flare up typically. So if it irritates, just back off for a few days (or more) and then return to it. It takes time and patience to rebuild that tissue, just as it takes time for our hair to grow out or our nails to grow long. Others have no irritation and can use it more often. Once you are well, you definitely should taper down to a maintenance dosage. (For me, it was twice a week for a few years, and now I can get away with once a week, and sometimes twice.)
Initially it took me approximately six full months of use (topically only) to see the full effects - although the unfusing took place probably by the end of the 3rd month or so. But I used 'very little' initially because I was so bad. I often could only use it every 3rd or 4th day as it irritated me quite a bit and my tissue was extremely excoriated. Some it won't bother at all. But I always returned to it no matter how little I used. I 'knew' it would work and knew of its tremendous benefits and it did. So I beg you to not get discouraged.
Estrace is a brand name and only comes in one strength and is available at all local drugstores in the US via prescription. The main ingredient is called '17b Estradiol' - our mother hormone and what we produce our whole lives and lose as we go into menopause and is what the skin lives and thrives on and is nourished and fed by. It can also be compounded at a compounding pharmacy with just the 17b Estradiol (estrogen) *the main ingredient in the name brand Estrace* to leave out some of the irritating bases in the name brand Estrace. Some compounders may use Olive oil as a base or Acquafor, or especially Liquigel. Another good one suggested is Emu oil for those who may be extra sensitive. I wasn't aware of compounding pharmacies years ago unfortunately, but am well versed today.
If Estrace is not available in your country, you might ask to have ESTRIOL compounded. Estriol is one of 3 estrogens we produce, and considered a milder one than estradiol. One name is Ovestin; another is Ortho-Gynest *not available in the US* from my understanding, that can work as well for tissue restoration, even if it might be slower process - it can be very effective as well. You most likely have Premarin, (name brand of an estrogen cream) which can be used, though not preferred since it's simply not natural to us at all but better than nothing if you can't get Estrace which is exactly bio-identical to our own hormones. I would insist on the Estrace if it were me and is available in the US.
Estrace (estradiol) cream can be used topically 'once' a night if you can, (bedtime is best). If it irritates you, (and it may) just back off for a few days and go back to it. If it doesn't irritate, then twice a day, (pea size) a short while may be even more beneficial and would speed up the healing. But don't be a martyr or think you have to use it and suffer or endure.
Take it easy on yourself. It has very little if any systemic absorption used topically and usually can be used by all ages, even children. There are many legitimate studies that show it absolutely can work to unfuse labial adhesions in children, as the above link shows its benefits and that small children can use it without fear of side effects. I myself wouldn't be concerned at all with the small dab we use topically... and 'I've' been using it for more than 9 yrs with no side effects at all. By the way I've seen several legitimate studies where they've used it in 'male' children as well who have BXO (a male version of LS but not long term and it also helped them.
Here's just one link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10701883&dopt=Abstract
Be certain to tell your physician you want to use it 'topically,' as most will assume it's to be used 'intravaginally' and rarely do they think of it for topical use. Most aren't even aware that it can work topically. If you don't, they may hesitate to give it to you, especially if you are younger.(Just toss the applicator that comes automatically with it.)
Again, just a small pea size dab or to make a light film over the affected area and gently massaged in. One can also use what I've named the'Q-tip 'twirl' in the clitoral shaft if pain in that area or a fused clitoral shaft. (I also put the Testosterone cream on the Q-tip as well).
Also, once healed, we do have to taper down and go only on a maintenance dosage. Do not overuse it. Estrace can/may irritate (generally it's the base it's in) so must be used slowly. If in a flare up, it's not used for its soothing qualities, so just let things 'simmer down' a bit and back off - but do consider going back to it.
Again, do NOT overuse any of these meds. Patience is a real virtue here. Also once healed, please remember to taper down to a maintenance level. Don't continue the constant every day usage - whether it's a steroid OR the hormone creams. Mine is now twice a week average of the E & T topically to 'keep' me well as it has for the last 9 plus yrs and no steroid usage needed at all and no flare ups. (After suffering horribly for 10 long years).
Estrace cream too must be gently massaged in (that's important for all of these medications). You do NOT want to just let any of them lay on the tissue. 'Once' a night before bedtime I feel is the best time to use the hormone creams (steroids daytime). Because nature does our best healing during sleep. (It has to do with our circadian rhythms.)