Current data support that vaginal estrogen is very safe and effective for most people, yet many clinicians are under-informed about and overly reluctant to prescribe treatment for menopausal symptoms.
“I’m struggling with post-menopausal vaginal symptoms, and my clinician only recommended a moisturizer, which doesn’t help much. Why didn’t they prescribe an estrogen cream?” – Becca in Wisconsin
Current data support that vaginal estrogen is very safe and effective for most people, yet many clinicians are under-informed about and reluctant to prescribe treatment for menopausal symptoms.
Menopause is a fact of life and brings a whole host of physical changes. Symptoms can be systemic, affecting the entire body, and/or local, affecting the vulva, vagina, and urinary tract. This second group is called the Genitourinary Syndrome of Menopause (GSM) and can include vaginal symptoms (like dryness, irritation, pain, and itching) and urinary symptoms, (such as urgency, frequency, incontinence, and even infections).
Genitourinary Syndrome of Menopause affects more than 50% of postmenopausal people and can worsen over time, unlike many systemic symptoms of menopause, such as hot flashes, which tend to improve with time.
✅ It’s effective!
Low-dose vaginal estrogen treatment is highly effective in treating most symptoms of Genitourinary Syndrome of Menopause. It’s available as a cream, tablet, or ring that is placed in the vagina, and studies show that all forms seem to work equally well.
Vaginal estrogen even decreases the number of urinary tract infections in postmenopausal women. Other therapies, such as moisturizers and lubricants, can be helpful for many (but not all) Genitourinary Syndrome of Menopause symptoms and can be used either instead of or in combination with local estrogen. Newer treatments, such as laser, have not yet been well studied.
✅ It’s safe!
Low-dose vaginal estrogen is very safe. It’s not absorbed by the body to any great extent and has no significant impact on blood hormone levels in most people. In fact, there is no increased risk of blood clots, stroke, or any of the other cardiovascular side effects seen with higher-dose or systemic estrogen. (Yet the FDA still requires this warning on vaginal estrogen prescriptions!) When it comes to breast and endometrial cancer, early data show no concerns, but individuals at high risk for these cancers should consult with their clinicians, as longer-term studies are still needed.
🤷♀️ Unfortunately, most clinicians are under-trained in this area, with only 7% of young physicians feeling adequately prepared to treat menopause in a 2019 study. There is also misplaced fear about hormonal therapies, due to misinterpretation of a large 2002 study (The Women’s Health Initiative) and to the FDA’s requirement that ALL forms of estrogen carry the same risk warnings, even when recent studies don’t support those claims. Put this all together and there is a lot of unnecessary suffering that goes untreated.
In summary, vaginal and urinary symptoms of menopause are very common and tend to get worse, rather than better, with time. Low-dose vaginal estrogen is a safe and effective treatment that’s been vastly under-prescribed for a variety of reasons. If you are struggling with symptoms, talk to your clinician to see if vaginal estrogen might be a good choice for you.
Stay safe, stay well,
Those Nerdy Girls
Check out our other posts on perimenopause and menopause here:
How can we older girls stay healthy sexually after menopause?
Hot flashes and mood swings in perimenopause! Make ‘em go away!
I am in perimenopause. What is happening to my brain?!
Further reading:
BMJ 2023 review of management of peri- and menopause, discusses evidence of risks and benefits
Current options for hormonal treatment of GSM
Needless suffering due to under-prescription of vaginal estrogen
Menopause being ignored, residual fear from WHI
Low knowledge and comfort with managing menopause – only 7% of young docs felt adequately informed
Genitourinary syndrome of menopause
Treatment options for postmenopausal vaginal atrophy
Vaginal estrogens don’t increase endometrial cancer risk short-term but long term studies are needed
Study shows no increased risk of VTE with vaginal estrogen
University of Southern Denmark and National Library of Medicine
Review study shows no significant impact of vaginal estrogen on serum hormone levels
No increased mortality in women with breast cancer who used vaginal estrogen
