Vaginal Estrogen

Unless you’ve been in an isolation chamber for the past few years, the words vaginal estrogen likely conjure an image of a 50-something woman fanning herself while having a hot flash. It’s true that vaginal estrogen is mainly used to help women of a certain age—think the perimenopausal and menopausal 40s and 50s—get more lubed down there. But that isn’t the only purpose of this local hormone treatment. “We use it as early as childhood, and as late as when a woman hits her 70s, 80s, or even 90s,” says Rachel Rubin, MD, a urologist and sexual medicine specialist in Bethesda, Maryland. “It’s safe and effective at all ages. In my opinion, it’s a disaster that it’s not being prescribed like candy.”

Here’s a closer look at vaginal estrogen—what it is, what it can treat, and why females may benefit from it, whether they’re 5 or 95.

What exactly is it?
Vaginal estrogen is, quite simply, an estrogen that you apply to your vagina. It comes in three forms: a cream, a tablet, and a vaginal ring. “It’s used to treat symptoms of vaginal dryness due to low levels of estrogen,” says JoAnn Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia Health System in Charlottesville, Virginia. You’ll usually use it once a day for two weeks to start, then two to three times a week for maintenance.

For most women, low levels of estrogen occur when they hit perimenopause. Vaginal estrogen is often prescribed at this point to treat symptoms like vaginal dryness, itching, and burning, a condition known as the genitourinary syndrome of menopause (GSM), explains Pinkerton. But there are other times in life when you may benefit from it too. 

Who needs vaginal estrogen, and why?
Simply put, “any woman who is low in estrogen is a candidate for vaginal estrogen,” says Stephanie S. Faubion, MD, medical director of The Menopause Society and director of the Mayo Clinic’s Center for Women’s Health. In fact, it’s been given to girls even as infants or toddlers. Here are some stages at which

Vaginal estrogen can be helpful while breastfeeding too. When you are nursing, high levels of other reproductive hormones such as prolactin inhibit your estrogen levels. This allows your body to create plenty of milk, but it also leads to vaginal dryness, says Faubion. A 2024 paper published in the journal Sexual Medicine Reviews found that about 18 percent of breastfeeding moms reported this symptom after six weeks. The paper also found that vaginal estrogen was safe and effective and wasn’t passed to the baby through breast milk. “You have way higher levels of estrogen in your body when you’re actually pregnant,” reassures Faubion.

Perimenopause. In your late 30s or 40s, you may notice that you get more frequent urinary tract infections. It’s not a coincidence. “Just like your vaginal tissues start to thin out, your bladder lining also thins and becomes less elastic,” explains Pinkerton—all of which makes you more vulnerable. The most recent American Urological Association guidelines recommend that all doctors suggest vaginal estrogen therapy to their peri- and postmenopausal patients with recurrent UTIs. “The vaginal estrogen plumps your tissue out, making it more acidic and less favorable to bacteria that can cause a UTI”.

Menopause and beyond. This is when GSM can really wreak havoc, causing painful sex along with frequent pesky UTIs. The answer? You guessed it. A 2023 study coauthored by Rubin and published in the journal Urology Practice found that vaginal estrogen can reduce the risk of recurrent infections by more than 50 percent among female Medicare patients. “It’s important because the older you are, the more likely a UTI is to land you in the hospital,” says Rubin. “UTIs represent up to a third of total Medicare spending for people over age 65. If there was a greater push to use vaginal estrogen, we could save Medicare billions of dollars.”

About that scary warning label
When you pick up your tube of vaginal cream from the pharmacy, you’ll see a warning on the box saying it raises the risk of endometrial cancer, cardiovascular disorders, breast cancer, and even dementia. Understandably, you may freak out—but it’s simply not accurate. “In 2003, the FDA put a blanket warning on all estrogen products, even though local estrogen that you use as a cream or tablet is much safer than taking it by mouth as a pill,” explains Rubin. “Since it’s inserted into vagina very little, if any, gets into your bloodstream.” More reassurance: In 2022, the U.K. equivalent agency to the FDA, the Medicines & Healthcare products Regulatory Agency, conducted an extensive safety review and reclassified a certain form of vaginal estrogen known as Gina 10 from a prescription to an over-the-counter medication. “All this boxed warning does is make both women and their doctors afraid to use safe, effective medication,” Rubin stresses.


The bottom line
If you are experiencing vaginal dryness or get repeat urinary tract infections, make an appointment with your ob-gyn or primary care professional. “We always like to do a thorough evaluation,” says Faubion.