Medically Reviewed by Dr. Patricia Shelton, MD

During perimenopause and after menopause, many women experience symptoms like vaginal dryness and pain during intercourse. These are symptoms of vaginal atrophy, which affects around half of all postmenopausal women. This condition occurs because when the body’s estrogen levels drop, the tissues of the vagina become thinner. What can solutions be and which role does vaginal estrogen cream play?

What’s the difference between vaginal estrogen cream and HRT?

Systemic hormone replacement therapy, or HRT, involves administering hormones to the entire body. They can be taken orally or absorbed through the skin via a cream or patch. In this form of treatment, the goal is to raise the levels of estrogen in the blood.

Vaginal estrogen therapy is a local estrogen treatment, rather than systemic HRT. It’s applied directly inside the vagina, so it preferentially affects the tissues in this area. While some of the estrogen may be absorbed through the vagina, the dose used in vaginal estrogen therapy is lower than for systemic HRT, so it won’t raise blood estrogen levels nearly as much.

Vaginal estrogen is more effective at relieving symptoms of vaginal atrophy than systemic HRT is. In fact, some women taking systemic HRT still experience symptoms of vaginal atrophy. If you’re on HRT, and you’re having symptoms like vaginal dryness or pain with intercourse, then you can still consider using vaginal estrogen along with your HRT.

How do you use vaginal estrogen cream?

The FDA has approved two main forms of vaginal estrogen cream – estradiol and conjugated estrogens. Estradiol is available in both brand name and generic forms, while conjugated estrogens come only in a brand name form.

The cream is applied inside the vagina every night for two weeks, and then one to three times a week for maintenance. Your doctor may direct you to take a week off from using it every four weeks. Your doctor may also adjust your dose upward or downward, depending on how your body responds to the treatment. The goal is generally to use the lowest dose that’s effective at relieving your symptoms.

A plastic applicator is used to insert the cream into the vagina. You need to squeeze the cream into the applicator from the tube that it comes in. The applicator is marked with the correct dosage, although it can be difficult to be precise with the dose measurement. You then lie on your back, insert the applicator into the vagina, and push the plunger to deliver the cream. The applicator must be washed and dried between uses.

What other forms of vaginal estrogen are available?

Vaginal estrogen comes in a few different forms. Besides creams, it can be applied in the form of a ring, a capsule, or a tablet. The main difference is in how often they will need to be applied. The ring is inserted and left in place for about three months. The capsules and tablets are generally used daily for the first two weeks, and then a few times a week after that.

The choice of which form of vaginal estrogen to use comes down to personal preference. The dose is generally lower with the ring, tablet, or capsule options than it is with a cream. Creams may use a somewhat higher dose, and it can be more difficult to precisely control the dose with a cream. However, some women may be able to feel the other options (especially the ring, since it remains in place for months), and may find a cream to be more comfortable.

Important Questions About Vaginal Estrogen Cream

1. Is vaginal estrogen cream safe for long term use?

2. Do you need a prescription for vaginal estrogen?

The answers to these 2 questions are exclusive to our perry community.

Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.

Sources

Bleibel B, Nguyen H. Vaginal Atrophy. StatPearls (National Library of Medicine). https://www.ncbi.nlm.nih.gov/books/NBK559297/. Accessed 9 April 2023.

Santin RJ, Mirkin S, et al. Systemic estradiol levels with low-dose vaginal estrogens. Menopause. 2020 Mar; 27(3): 361–370. doi: 10.1097/GME.0000000000001463

Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018; 10: 387–395. doi: 10.2147/IJWH.S158913

Rosenblum N. Update in Female Hormonal Therapy: What the Urologist Should Know. Rev Urol. 2020; 22(4): 182–185.

Bhupathiraju SN, Grodstein F, et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause. 2018 Dec 17; 26(6): 603–610. doi: 10.1097/GME.0000000000001284

Chambers LM, Hermann A, et al. Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma. Int J Gynecol Cancer. 2020 Apr;30(4):515-524. doi: 10.1136/ijgc-2019-001034.