Vaginal Estrogen

As women age, it’s typical to experience changes in vaginal health.

This can show up as a wide variety of things from painful intercourse to recurrent urinary tract infections. Genitourinary syndrome of menopause, formerly known as vulvovaginal atrophy, is a title used to describe the physical changes a woman’s body undergoes as estrogen hormone levels decline and ultimately deplete. Since the changes are not limited to the vagina, this new term, GSM, better describes the symptoms and conditions that many women struggle with during perimenopause and menopause.

Changes with Perimenopause and Menopause

The walls and skin of the vagina become thin, dry, and sometimes inflamed. This leads to vaginal burning, irritation, and pain–especially during intercourse, bleeding, or discharge. Some women have urinary symptoms like increased frequency of urination or pain when urinating. The vaginal changes that happen can shift the microbiome of the vagina (the bacteria), and this can lead to increased urinary tract infections as well.

Vaginal Estrogen to the Rescue

Estrogen replacement therapy, a component of hormone replacement therapy, can be very confusing. There has long been controversy over the safety of estrogen replacement therapy; however, much of the controversy has been unfounded.

Your options for hormone estrogen replacement therapy

It is important to understand the difference between two different types of hormone therapy: systemic therapy vs. localized therapy. Systemic estrogen replacement therapy is replenishing total body estrogen to premenopausal levels in an effort to prevent many chronic diseases of aging like heart disease. Localized estrogen replacement therapy is low-dose estrogen applied directly to the vaginal area for the sole purpose of treating concerns and maintaining vaginal and urinary health.

Where this can get confusing is a doctor can prescribe systemic therapy via a compounded cream to be applied vaginally. If you are using vaginal cream, talk to your doctor about which type of replacement you are using. A tell-tell sign of local vaginal treatment is the dose of your cream as localized treatments are a very low dose. Creams are not the only options for localized vaginal estrogen. Tablets and rings are also commercially available, and you can talk to your doctor about your options. These low-dose treatment options stay local to the vagina meaning no significant amount is absorbed systemically. This makes vaginal estrogen local treatment safe for just about every woman–even those with active cancers.