Short answer: The Estrace Cream label gives a usual dose of 2 to 4 g, measured on the applicator, daily for one or two weeks, then about half that dose for a similar period. Once the vaginal lining has recovered, a maintenance dose of 1 g one to three times a week may be used. The label uses the lowest dose that controls symptoms and has no missed-dose rule.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Estrace Cream is approved for: Estrace Cream is an estrogen cream approved to treat moderate to severe symptoms of vulvar and vaginal atrophy due to menopause (Indications and Usage). Each gram contains 0.1 mg estradiol (Description). The label says some estrogen is absorbed into the body, so the warnings for oral estrogen are taken into account (Warnings).
Source
ESTRACE (estradiol vaginal cream USP 0.01%), prescribing information and Patient Information. Allergan (AbbVie). DailyMed, version published November 5, 2024. DailyMed setid dfc41fcd-c5ba-4b25-b647-cf04d3988b3e
Estrace Cream is placed in the vagina with the calibrated plastic applicator that comes with the tube, which measures 1, 2, 3 or 4 g. Each gram contains 0.1 mg estradiol (Description, How Supplied).
The Patient Information describes filling the applicator from the tube to the prescribed gram mark, then lying on the back with knees bent, inserting the applicator deeply into the vagina and pressing the plunger. The applicator is washed with mild soap and warm water, not boiled or hot water.
The tube holds 1 ½ oz (42.5 g). The label says the number of doses per tube varies with the dose and handling (How Supplied, Dosage and Administration).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Phase | What the label says |
|---|---|
| Start | 2 to 4 g (marked on the applicator) daily for one or two weeks |
| Then | Gradually reduced to one half initial dosage for a similar period |
| Maintenance | 1 g, one to three times a week, may be used after restoration of the vaginal mucosa has been achieved |
| Goal | The lowest dose and regimen that will control symptoms; discontinued as promptly as possible |
Use, alone or with a progestin, is limited to the shortest duration consistent with treatment goals and risks, and the need for treatment is re-evaluated periodically. The Patient Information gives every 3 to 6 months as an example of how often to talk about the dose.
For women with a uterus, undiagnosed persistent or recurring abnormal genital bleeding is checked, including endometrial sampling when indicated.
For a woman who still has a uterus, adding a progestin for 10 or more days of a cycle, or daily, lowered the rate of endometrial hyperplasia compared with estrogen alone. For women with residual endometriosis after hysterectomy, adding a progestin should be considered.
If feasible, estrogen is stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
The Estrace Cream label gives no missed-dose instruction. The dose and schedule are set by the prescriber; ask your prescriber or pharmacist what to do if a dose is missed.
In Dose Track you set up Estrace Cream as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.