Defogen Tablet — Estriol (Natural Estrogen) by Beximco Pharmaceuticals

Defogen Tablet — Estriol | Beximco Pharmaceuticals

Overview

Defogen Tablet contains Estriol — a naturally occurring estrogen hormone and the weakest of the three main endogenous estrogens (the others being estradiol and estrone). Unlike estradiol, estriol has predominantly local (tissue-specific) estrogenic activity, making it particularly suitable for treating urogenital symptoms of estrogen deficiency without the systemic effects associated with stronger estrogens. It is primarily used for the management of vaginal atrophy (atrophic vaginitis), urinary symptoms, and other urogenital manifestations of the menopause. Estriol is the estrogen of choice when local urogenital treatment is the primary goal, as its low systemic absorption minimises the risk of endometrial stimulation compared to systemic estrogens.

Mechanism of Action

Estriol binds to nuclear estrogen receptors (ER-alpha and ER-beta) in urogenital tissues — vaginal epithelium, urethra, pelvic floor musculature, and trigone of the bladder. This stimulates proliferation and maturation of the vaginal epithelium, restoring moisture, elasticity, and glycogen content. Restoration of glycogen supports re-establishment of the normal Lactobacillus-dominant vaginal flora and normal acidic pH, reducing susceptibility to recurrent urinary tract infections (UTIs). Estriol has low systemic bioavailability after oral administration compared to estradiol and does not significantly stimulate endometrial proliferation at standard doses used for urogenital symptoms.

Indications

• Atrophic Vaginitis (Vaginal Atrophy) — dryness, soreness, dyspareunia (painful intercourse) due to estrogen deficiency in post-menopausal women
• Urogenital Atrophy — urinary urgency, frequency, stress incontinence, recurrent UTIs associated with estrogen deficiency
• Postmenopausal symptoms — local estrogen replacement for women not requiring or not suitable for systemic HRT
• Pre- and post-operative treatment — in post-menopausal women undergoing vaginal surgery, to improve tissue quality
• Atrophic urethritis — inflammation of the urethra due to estrogen deficiency

Dosage and Administration

Take with or without food. Take at the same time each day. Do not take more than prescribed. Hormone therapy should always be reviewed regularly by the prescribing physician — do not use long-term without periodic assessment.

Important Warning for Diabetic Women

Postmenopausal women with diabetes are at significantly increased risk of urogenital complications due to the combination of estrogen deficiency and hyperglycaemia — poorly controlled blood glucose promotes vaginal and urinary tract infections, causes additional mucosal dryness, and impairs tissue healing. Estriol can provide targeted relief. Key considerations:

• Glycaemic control and estrogens: Estrogen therapy (particularly systemic) can influence insulin sensitivity. Estriol's predominantly local activity minimises systemic metabolic effects, but blood glucose monitoring is advisable when starting any hormonal therapy.
• Recurrent UTIs in diabetic women: Estriol restores Lactobacillus-dominant vaginal flora and normal acidic pH, which significantly reduces recurrent UTIs — a common complication in diabetic women. This makes estriol a valuable option for diabetic postmenopausal women with recurrent lower UTIs.
• Cardiovascular and thrombotic risk: Systemic estrogen therapy carries increased risks of VTE (venous thromboembolism), stroke, and cardiovascular events — risks already elevated in diabetic women. Estriol with predominantly local action minimises but does not entirely eliminate systemic estrogen exposure. Discuss cardiovascular risk with your physician.
• Body weight: All estrogen therapies may cause fluid retention or weight changes — monitor weight and blood pressure regularly in diabetic women.

Contraindications

• Known or suspected estrogen-sensitive cancer (breast cancer, endometrial cancer)
• Undiagnosed abnormal vaginal bleeding
• Active or history of venous thromboembolism (DVT, pulmonary embolism)
• Active arterial thromboembolic disease (recent MI, stroke)
• Acute or severe liver disease
• Porphyria
• Pregnancy and breastfeeding

Precautions and Monitoring

• Annual review of therapy — continued use should only be if symptoms persist and benefits outweigh risks
• Endometrial surveillance — if used with a uterus (particularly systemic estriol), assess for any unscheduled bleeding
• Mammography — as per age-appropriate breast screening guidelines during HRT use
• Blood pressure monitoring — particularly in hypertensive or diabetic women

Drug Interactions

Storage

Store below 25°C in a dry place. Protect from light and moisture. Keep in original packaging. Keep out of reach of children.

FAQ

Q: What is the difference between estriol and other estrogens like estradiol?
Estriol is the weakest and most locally acting of the three main estrogens. It binds estrogen receptors transiently and with lower affinity than estradiol. This makes it effective for local urogenital tissues (vagina, urethra, bladder trigone) without strongly stimulating other estrogen-sensitive tissues like the breast or endometrium. For women who only need relief from vaginal dryness, discomfort, or recurrent UTIs — without needing systemic HRT for hot flushes or bone protection — estriol is the preferred option.

Q: I am a diabetic postmenopausal woman with recurrent vaginal infections — can estriol help?
Yes. Estrogen deficiency after menopause causes thinning and dryness of the vaginal epithelium, loss of the glycogen-dependent Lactobacillus flora, and rise in vaginal pH — all of which predispose to bacterial vaginosis, candidal infections, and recurrent UTIs. Poorly controlled blood glucose (common in diabetic women) compounds this problem. Estriol restores vaginal epithelial health, acidic pH, and Lactobacillus colonisation — reducing infection frequency. Discuss with your gynaecologist or physician.

Q: Do I need to take this forever?
Not necessarily. Estriol is used for the shortest duration at the lowest dose that reliably controls symptoms. Your physician will review at 3–6 monthly intervals. Some women can take a 3-month break and find symptoms have resolved sufficiently; others require ongoing low-dose maintenance therapy. This is an individual decision made with your physician.

Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. Hormone therapy must be prescribed by a qualified physician after thorough assessment of individual risk factors including cardiovascular health, cancer history, and metabolic conditions. Never start or stop hormone therapy without medical supervision.