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Better compliance with vaginal tablets than creams among postmenopausal women
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Postmenopausal women were more likely to regularly fill their prescription for vaginally administered local estrogen therapy when prescribed vaginal tablets vs. creams, according to a 9-year retrospective study from Israel.
“The disadvantages of [vaginal creams] include messiness, leakage and suboptimal adherence because of difficulty to measure the amount administered, leading to overuse or underuse of the [vaginal cream] or [vaginal gel], resulting in vaginal bleeding or inappropriate relief of the vaginal symptoms,” Alina Weissmann-Brenner, MD, of the department of obstetrics and gynecology at the Chaim Sheba Medical Center in Ramat Gan, Israel, and colleagues wrote.
Weissmann-Brenner and colleagues analyzed electronic health records from 3,802 postmenopausal women treated in the Central District of Clalit Health Services between 2006 and 2014. Eligible women were not prescribed hormone therapy in the 6 months leading up to the study and filled at least four consecutive prescriptions for vaginal tablets or creams during the study period. Compliance to treatment was defined as taking the prescription during recommended intervals; adherence was defined as the period the patient followed the therapy regimen. Prescriptions in Israel are given in advance for 4-month intervals, according to study background.
Within the cohort, 2,269 women used continuous monotherapy; 1,782 women were prescribed only vaginal gels/creams; 487 were prescribed only vaginal tablets. Researchers found that more women prescribed vaginal tablets purchased the medication repeatedly vs. those prescribed vaginal creams (64% vs. 39%); 314 women received at least one prescription for tablets vs. 699 women treated with creams.
At 6 months, 83% of women prescribed tablet therapy asked for another prescription, according to researchers, compared with 54% of cream users (P < .001). Women prescribed tablet therapy also had a longer mean duration of treatment vs. women prescribed cream or gel therapy (mean, 1,002 days vs. 787 days; P < .000006).
“The compliance and adherence to treatment in this study were better in women treated with [vaginal tablets] compared with [vaginal gel], with a mean duration of [vaginal tablets] usage 7 months longer than with [vaginal gel],” the researchers wrote. “Furthermore, when a woman switched therapy, it was mainly from [vaginal gel] to [vaginal tablets]. Possible explanations may be the fixed dosage of estrogen in the [vaginal tablets] compared with the subjective administration of the [vaginal gel], and the comfortable use of [vaginal tablets].”
Researchers noted that a relatively small number of gynecologists in the study area prescribed HT — among 91 gynecologists in the Central District, 55% never prescribed local estrogens.
“Nevertheless, the large size of our study cohort increases the reliability of our findings,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Mary Jane Minkin
The authors found that women on vaginal estrogen tablets refilled their prescriptions more regularly and more often than women using vaginal cream. The major reason women use tablets more regularly is for the convenience. Many women prefer a preloaded vaginal tablet because they don't have to fill an applicator. When women use vaginal creams, often, the cream can leak out; however, some women do feel the cream is more soothing.
There are disadvantages to vaginal tablets. For external dryness around the vulva and the entrance to the vagina (the introitus), the user really needs to apply cream digitally. The tablets will not moisturize the opening or the vulva. So, many of my patients have prescriptions for both creams and tablets — the tablets into the vagina, the cream around the opening.
In addition, vaginal tablets tend to be pricier.
Disclosure: Minkin reports consulting for Nature's Way, Novo Nordisk, Pfizer and Shionogi.
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