May 23, 2010

Vaginal Premarin Cream for Recurrent Nosebleeds?

It is an old trick of the trade where a physician may prescribe vaginal premarin cream to treat recurrent nosebleeds.

The premarin (estrogen) cream (just as it does when placed vaginally) causes the nasal mucosa lining to thicken thereby "burying" the superficial blood vessels that are often the culprits for recurrent nosebleeds. Application is by rubbing the cream 2-3X per day to the anterior wall of the nasal septum (Kiesselbach's plexus) where 90% of nosebleed sources are located.

Understandably, males may be reluctant to be prescribed this medication due to the small (but temporary) risk of breast enlargement given the very small amount that can be systemically absorbed (based on vaginal studies, less than 20 pg/ml).

Furthermore, given there are other good options for treating nosebleeds including nasal emollients, cauterization, and packing, this option is mainly for females who are scared to death of nasal cauterization/packing when other more conservative treatment fails.

The vast majority of research on use of premarin cream for recurrent nosebleeds is actually for treating individuals suffering from Hereditary Haemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Syndrome.

Use of estrogen in the treatment of familial hemorrhagic telangiectasia. Laryngoscope. 1982 Mar;92(3):314-20.

Local oestrogen for recurrent epistaxis caused by familial telangiectasia. J R Coll Gen Pract. 1988 May;38(310):227.

Hormonal management of hereditary hemorrhagic telangiectasia. JAMA 1952; 149:1376-1380.

Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia. Acta Otolaryngol. 2016;136(5):528-31. doi: 10.3109/00016489.2015.1129070. Epub 2016 Jan 25.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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