Hormone Therapy and Vaginal Estrogen

“Vaginal oestrogen is a hormone replacement therapy (HRT)
medicine that contains the hormone oestrogen.
It’s used to treat the vaginal dryness and irritation…”.1

Umbrella

What may the Hormone Therapy and Vaginal Estrogen Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Local Low-Dose Estrogen Therapy
  • Menopausal Hormone Therapy (MHT)
  • Topical Vaginal Estrogens
  • Vaginal Estrogen/Oestrogen

Genitourinary Syndrome of Menopause (GSM)

What is the genitourinary syndrome of menopause (GSM)?

DotS the definition of GSM may vary. On page one in Genitourinary Syndrome of Menopause, published May 2025, the (United States) Menopause Society’s (formerly the North American Menopause Society) definition is:

“The genitourinary syndrome of menopause (GSM) includes bothersome vaginal, vulvar (lips of the vagina), and urinary symptoms that can affect quality of life, sexual satisfaction, and even your relationship with your partner. Unlike hot flashes, which typically improve with time, GSM usually worsens over time without treatment”.2

Vaginal Estrogen

What is vaginal estrogen?

DotS the definition of vaginal oestrogen may vary. In Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen the NHS definition is:

“Vaginal oestrogen is a hormone replacement therapy (HRT) medicine that contains the hormone oestrogen. It’s used to treat the vaginal dryness and irritation that can happen during the menopause”.3

Recommendation

When is vaginal estrogen recommended?

On page one in Deciding About Hormone Therapy Use, published February 2025, the Menopause Society explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina”.4

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy, published online 30 October 2023, the authors note:

“Urogenital symptoms due to estrogen insufficiency are under-recognized and under-treated. These symptoms can be effectively treated with an array of local therapies including intravaginal estrogen preparations or DHEA (prasterone) and intravaginal moisturizers. Concurrent progestogen therapy is not required. Many women require local therapy, in addition to systemic MHT, to relieve urogenital symptoms. It is important patients understand that treatment needs to be ongoing and is not simply a short course of therapy”.5

Cream, Tablet, Pessary or Ring

How can estrogen be applied directly to the vagina?

In Vulvovaginal Atrophy: Topical Vaginal Estrogens the European Menopause and Andropause Society explain:

  • “These may contain estradiol, estriol, promestriene and conjugated estrogens
  • Preparations include tablets, rings, capsules, creams, gels and ovules
  • Most are low-dose and do not change systemic estrogen levels
  • There is no need to add progestogen (for endometrial protection) when low-dose topical estrogens are used
  • They can be used alone or with systemic menopausal hormone therapy
  • They may also improve urinary incontinence and prevent recurrent urinary tract infections
  • They do not increase the risk of endometrial cancer, breast cancer, venous thromboembolism or cardiovascular disease”.6

Duration

How long can vaginal estrogen be used for?

On page three and four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published online 10 June 2022, one of the recommendations is:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.7

Compounded Vaginal Estrogen and Testosterone

Are compounded vaginal estrogen and testosterone recommended?

On page two in Genitourinary Syndrome of Menopause the Menopause Society include:

“Compounded vaginal estrogen and testosterone are not government regulated or recommended for treatment of GSM in most cases”.8

What is FDA?

FDA in the context above, is an abbreviation for the (United States) Food and Drug Administration.

What is GSM?

GSM in this context, is an abbreviation for the Genitourinary Syndrome of Menopause.

Health Care Provider

What if my vaginal symptoms do not improve with treatment?

On page two in Genitourinary Syndrome of Menopause the Menopause Society also note:

“Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.9

Health Topics A-Z

Where may I find Health Topics A-Z related to Hormone Therapy and Vaginal Estrogen?

In Health Topics A-you may find:

Health Topics A-Z

Links

Where may I find Links related to Hormone Therapy and Vaginal Estrogen?

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Links

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  6. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  7. Deciding About Hormone Therapy
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  9. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  10. Endometrial Safety of Low-Dose Vaginal Estrogens
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  30. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
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  32. Hormone Replacement Therapy (HRT): Vaginal Oestrogen
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  35. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
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  42. International Society for the Study of Women’s Sexual Health: Find A Provider
  43. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  44. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing, Intimacy and Menopause [+ Video: Menopause Is the End of Your Sex Life] [Other Languages and Formats]
  45. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Supporting Someone Through the Menopause [+ Video: Men Don’t Need To Know About Menopause] [Other Languages and Formats]
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  60. Menopause: Identification and Management: NICE Guideline [NG23] [07 November 2024]
  61. Menopause: Menopause – Hormone Treatments
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  70. Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)
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  72. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
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  75. Sheplusfoundation.com [She+ Foundation [formerly The Patty Brisben Foundation of Women’s Sexual Health]]
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  100. Hormone Therapy and Vaginal OestrogenWorld Menopause Day 2024: Poster for Women – The 5 Ws of Menopause Hormone Therapy (MHT)

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen. Page Last Reviewed: 27 January 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/ Accessed: 31 July 2025
  2. Genitourinary Syndrome of Menopause. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 31 July 2025
  3. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen. Page Last Reviewed: 27 January 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/ Accessed: 31 July 2025
  4. Deciding About Hormone Therapy Use. 2025:1. Menopause Society https://menopause.org/wp-content/uploads/default-document-library/MenoNote-Deciding-About-HT-2025.pdf Accessed: 31 July 2025
  5. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Effectiveness: Local Treatment of Urogenital Atrophy. First Published Online 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 31 July 2025
  6. Vulvovaginal Atrophy: Topical Vaginal Estrogens. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 31 July 2025
  7. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 31 July 2025
  8. Genitourinary Syndrome of Menopause. 2025:2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 31 July 2025
  9. Genitourinary Syndrome of Menopause. 2025:2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 31 July 2025
Topic Last Updated: 31 July 2025 – Topic Last Reviewed: 31 July 2025

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