From waste to wellness - what women want: insights into patient perspectives on topical vaginal estrogen applicators and environmental considerations.

Objective: Environmental consciousness and the role of plastic waste are increasing. Topical vaginal estrogen prescription can be prescribed with one reusable plastic applicator or multiple single-use plastic applicators. User preference about the role of plastic in personal healthcare is not fully understood. This study aimed to explore patients' perspectives on the applicator and environmental considerations.

Method: A mixed-methods questionnaire was employed to assess users' experience with topical vaginal estrogen applicators and their views on the environment.

Results: Ninety-two respondents had previously used estriol 0.1% cream and 77 had used estradiol 10 μg vaginal inserts. The mean age of participants was 67.3 years. The mean duration of use was 36.5 months, and the discontinuation rate was 26.1% and 29.9% for estriol 0.1% cream and estradiol 10 μg vaginal insert users, respectively. Satisfaction with applicators and ease of use were similar in both groups. There was a higher report of the product being 'messy' (38.0% vs. 18.2%; p = 0.026) and 'not hygienic' (48.9% vs. 18.2%; p < 0.001) by estriol 0.1% cream users compared to estradiol 10 μg vaginal insert users. Women aged <65 years demonstrated a greater concern about plastic use and the impact on the environment compared to women aged over 65 years (81.0% vs. 56.9%; p = 0.002). The younger cohort showed a preference for reusable applicators (66.2%) compared to single-use applicators (33.8%) (p = 0.005). There was no statistically significant difference in preference for women aged over 65 years.

Conclusion: This study demonstrates that younger postmenopausal women showed greater concern for plastic waste and its impact on the environment, with a preference for reusable products. Manufacturers of health products and prescribers should be aware of this growing trend. With similar overall satisfaction and side-effect profiles, users should be made aware of the different types of applicators available to help support an informed decision.