Vaginal estrogen is an effective, low-risk form of hormone therapy (HT). It is used to treat genital and urinary symptoms of menopause including vaginal tightness, dryness, pain during sex, frequent urination, and recurrent urinary infections. Vaginal estrogen can be taken alone or along with systemic HT like tablets or patches. Read on to learn why vaginal estrogens are a safe and popular option.
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Why does the vaginal area change at menopause?
Estrogen keeps the tissues in your vagina, vulva, and urethra plump, moist, and elastic, as well as resistant to infection. This is especially true throughout your younger adult life when estrogen levels are high.
As you might expect, as estrogen levels drop during menopause, the tissues of your vagina and wider genital area can become thin, dry, and fragile.
This leads to several symptoms that are grouped together and known collectively as genitourinary syndrome of menopause (GSM). These include vaginal dryness, vulvar discomfort, itchiness, and tightness. These can lead to painful sex and bladder issues, such as repeated infections. You may also hear GSM referred to by older terms such as vaginal atrophy, vulvovaginal atrophy, or atrophic vaginitis.
GSM is a common problem, but fortunately it can be treated effectively with the right medication. While many menopause symptoms – including hot flashes – settle after a few years, GSM symptoms continue long-term due to ongoing low estrogen levels.
What is vaginal estrogen HT?
Vaginal HT is a way of supplying your genital area with the estrogen it no longer receives through your blood. The hormone is applied directly to your vagina or wider genital area, where it is absorbed directly into your tissues.
Vaginal estrogen is an effective form of HT that works well for GSM. It can be used alongside other forms of HT including patches, pills, and sprays if your “systemic symptoms” – hot flashes, poor sleep, mood swings – are also bothersome.
How does vaginal estrogen work?
Vaginal estrogen is absorbed through the tissues of your vagina and genital area and very little is absorbed into your blood. Vaginal estrogen is highly effective, but symptoms will return if you stop treatment.
The different types of vaginal estrogen
A number of different types of vaginal estrogen are available for HT. It doesn’t matter which form you use – they all work equally well. The most important thing is to find a type of vaginal estrogen that you’re comfortable using.
Options include:
- Vaginal creams
- Vaginal tablets
- Vaginal suppositories
- Vaginal rings
To start with, your healthcare provider will typically advise you to use a vaginal estrogen cream or tablet daily. Many people find that in the long term, they need to use their vaginal HT only once or twice per week to keep any problems at bay.
If you’re struggling with tightness or pain, a cream could be a good first choice as you might find it easier to apply than inserting a ring or suppository. These products can be applied externally if needed – ideal if you have any symptoms affecting your vulva or perineum (the skin between your vagina and anus).
A vaginal ring is a very convenient option as it remains in place for three months at a time to slowly release estrogen into the vagina and surrounding tissues.
Can vaginal estrogen be used on its own?
Vaginal estrogens can be used alone, and many people take this approach to successfully manage urogenital menopause symptoms.
You can also combine vaginal estrogens with other products to ease your symptoms. These could include:
- Vaginal moisturizers – to further ease dryness
- Lubricants – if sex is painful
Vaginal estrogen can also be used alongside systemic HT such as patches, pills, gels, and sprays, if you need them.
Unlike other forms of estrogen, you do not need to use progesterone if you’re taking vaginal estrogen alone.
A combination of estrogen and progesterone is always recommended for systemic HT if you still have your uterus. This is because using estrogen alone can cause abnormal thickening of the uterine lining and in some cases even cancer of the uterine lining. Progesterone removes this risk.
However, this is not necessary if you just use estrogen for vaginal HT. This is because the estrogen remains in the area where it is applied and very little is absorbed into your blood.
Is vaginal estrogen safe?
Vaginal estrogen is a low-risk form of HT. It can even be considered safe for people who are not felt to be eligible for other types of HT, for example, because of a history of breast cancer, blood clots, or advanced heart disease.
Ask your healthcare provider to recommend the best treatment for you, as even vaginal HT is not suitable for everyone.
Side effects of vaginal HT
As the hormones stay in one area of your body, you should have few – if any – side effects.
The exception to this is in the first few days after starting your treatment. Some estrogen can end up in the bloodstream because it is more easily absorbed through the damaged tissues of your vagina. At this time, you might notice mild breast tenderness, breast tingling, or abdominal bloating, among other mild symptoms.
Once the medication starts working, your vaginal tissues become plumper and thicker. At this point, the absorption of hormones into the bloodstream becomes even less.
Local side effects are also possible. Some women notice itching or irritation of the skin in and around the vagina, although this tends to settle within a few weeks. If these symptoms don’t improve, then speak to your healthcare provider about trying a different form of vaginal HT.
Vaginal HT and contraception
You should be aware that vaginal estrogen creams can damage condoms, so you will need to use another effective form of contraception if you are still potentially fertile and sexually active. It can be difficult to work out the best options for contraception as you approach menopause, so speak to your healthcare provider for further advice.
Read more about contraception during menopause.
Final word
Vaginal estrogens are an effective and low-risk treatment for symptoms of menopause including vaginal dryness, itchiness, pain during sex, frequent urination, and recurrent urinary tract infections. These symptoms are often difficult to talk about but be assured that they are common and can be easily solved with the right medication – tell your healthcare provider if they are bothering you!
Find out more about menopause on our blog or in our symptoms library.
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