Hormone Therapy and Vaginal Estrogen

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

Definition

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”.2

Recommended

When is vaginal estrogen recommended?

On page one in Deciding About Hormone Therapy Use 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”.3

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”.4

Vaginal Estrogen Cream

What is vaginal estrogen cream?

In How To Use Vaginal Oestrogen Cream – Menopausal Hormone Therapy: What Is Vaginal Estrogen Cream?, dated 07 May 2026, the (Australian) Jean Hailes for Women’s Health (JH) explain:

“Menopausal hormone therapy (MHT) is used to treat menopausal symptoms. There are different types of MHT, including vaginal oestrogen cream.

Vaginal oestrogen cream is also called topical vaginal oestrogen. It contains a low dose of oestrogen. It’s mainly used for:

  • Vaginal dryness and itching
  • Painful sex
  • Some urinary symptoms, such as a burning feeling when you wee, needing to wee urgently and getting urinary tract infections often”.5

The JH also clarify:

“Vaginal oestrogen cream is only effective for managing bladder, vaginal and vulval symptoms. It can be used alone or with other forms of MHT.

It may take 8 weeks of treatment to get the best effect”.6

Vaginal Pessaries

What are MHT vaginal pessaries?

In How To Use Vaginal Pessaries – Menopausal Hormone Therapy: What Are MHT Vaginal Pessaries?, dated 07 May 2026, the JH explain:

“MHT vaginal pessaries are tablets or soft capsules that you insert in your vagina. They release a low-dose of oestrogen and are used to treat symptoms like vaginal dryness, itching, burning and painful sex.

They can be used alone or with other forms of MHT.

There are two types of pessaries:

  • With an applicator – a small device that helps you insert the pessary into your vagina
  • Without an applicator – you insert the pessary into your vagina using your finger”.7

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”.8

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”.9 

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”.10

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

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Links

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New or Updated

  1. 3D Mapping of Female Anatomy
  2. A Man’s Guide To Menopause
  3. Anatomy of the Vagina
  4. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  5. BMS TV: Hormone Replacement Therapy (HRT)
  6. BMS TV: Testosterone Explained
  7. BMS TV: Urogenital Atrophy
  8. Bioidentical Hormones: Are They Safer?
  9. Bladder Leakage: How To Talk To Your Doctor
  10. Breast Cancer Survivors Find Relief for Debilitating Menopause Symptom
  11. Caredownthere.com.au
  12. Consumer Video and Podcast Series: 2024 Consumer Videos and Podcasts – Preparing for Your Menopause Health Care Visit
  13. Deciding About Hormone Therapy
  14. Deciding About Hormone Therapy Use
  15. “Doctor, is it normal?” [Genitourinary Syndrome of Menopause (GSM)
  16. EMAS On-Demand Webinars [European Menopause and Andropause Society] [Multiply Languages]: Genitourinary Syndrome of Menopause (GSM): Diagnosis and Evidence-Based Management
  17. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  18. Estradiol Vaginal Cream
  19. Estradiol (Vaginal Route)
  20. Estradiol (Vaginal Route): Before Using
  21. Estradiol (Vaginal Route): Brand Name US
  22. Estradiol (Vaginal Route): Proper Use
  23. Estradiol (Vaginal Route): Side Effects
  24. Experiencing Vaginal Dryness? Here’s What You Need To Know
  25. FAQs: Vulvovaginal Health
  26. FDA Direct: Removing Black Box Warnings for HRT (Part 1/2)
  27. FDA Direct: Removing Black Box Warnings for HRT (Part 2/2)
  28. Find A Menopause Practitioner [United States and Other]
  29. Find A Practitioner [Australasian Menopause Society i.e. Australia and New Zealand]
  30. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  31. Gaslighting of Genitourinary Symptoms of the Menopause
  32. Genitourinary Syndrome of Menopause
  33. Genitourinary Syndrome of Menopause (GSM)
  34. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025)
  35. HRT Questions Answered
  36. HRT Types and Doses | Dr Louise Newson
  37. HRT – Types, Doses and Regimens
  38. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review
  39. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT)
  40. Hormone Replacement Therapy (HRT): Vaginal Oestrogen
  41. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – About Vaginal Oestrogen
  42. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Common Questions About Vaginal Oestrogen
  43. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  44. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Side Effects of Vaginal Estrogen
  45. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Using Vaginal Oestrogen With Other Medicines and Herbal Supplements
  46. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Who Can and Cannot Use Vaginal Oestrogen
  47. Hormone Therapy: Is It Right for You?
  48. How To Manage Menopausal Symptoms: Managing, Bladder, Vaginal and Vulval Problems
  49. How To Use Vaginal Oestrogen Cream – Menopausal Hormone Therapy
  50. How To Use Vaginal Pessaries – Menopausal Hormone Therapy
  51. How Vaginal Hormones Can Transform Lives | The Dr Louise Newson Podcast
  52. International Menopause Society (IMS) Recommendations and Key Messages on Women’s Midlife Health and Menopause
  53. International Society for the Study of Women’s Sexual Health: Find A Provider
  54. 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
  55. 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]
  56. 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]
  57. Lubricant Alternatives: What To Use and What To Avoid
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  61. Menopause Ruining Your Sex Life?
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  63. Menopause: Identification and Management [NICE Guideline]
  64. Menopause: Identification and Management [NICE Guideline]
    Hormone Therapy and Vaginal Estrogen
  65. Menopause: Menopause – Hormone Treatments
  66. Menopause: Things You Can Do
  67. Navigating Menopause Together: How Partners Can Help
  68. Navigating Menopause Care Resource Guide
    Hormone Therapy and Vaginal Estrogen
  69. Online Events [International Menopause Society]: IMS Partnership Symposia Series – Dyspareunia – Vaginal Atrophy and Beyond [Webinar] [ Sign In To Confirm Your Age]
  70. Online Events [International Menopause Society]: Past Webinars – 2025: The Burn, the Itch, the Pain, the Urge: GSM In Women
  71. Online Events [International Menopause Society]: Past Webinars – 2026: New IMS Recommendations – Midlife Body Changes
  72. Perimenopause and Menopause Checklist: Translated Checklists
  73. Perimenopause and Menopause Symptom Checklist
    Hormone Therapy and Vaginal Estrogen
  74. Prasterone for Vulvar and Vaginal Atrophy In Postmenopausal Women
  75. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
  76. Risks and Benefits of MHT
  77. Shedding Light on the Menopause Experience and Demystifying Treatment
  78. Sheplusfoundation.com [She+ Foundation [formerly The Patty Brisben Foundation of Women’s Sexual Health]]
  79. Talk About Painful Sex
  80. The Menopause Society Statement on Misinformation Surrounding Hormone Therapy
  81. The Role of Topical Vaginal Oestrogen
  82. The Vulva & Vagina Explained: Sex Ed #2
  83. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  84. Topical Vaginal Oestrogen for Breast Cancer Patients
  85. Vaginal Atrophy
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  90. Vaginal Laser Therapy for GSM/VVA: Where We Stand Now – A Review By the EUGA Working Group on Laser
  91. Videos & Podcasts: Videos – Menopause and Hormone Therapy: Current Perspectives and Controversies
  92. Vulva and Vagina [Multiply Languages]
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  96. What Types of Vaginal Oestrogens Are There?
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  98. Why You Get An Itch or Thrush on Vaginal Estrogen and What To Do About It
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    Hormone Therapy and Vaginal Estrogen

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: 21 June 2026
  2. 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: 21 June 2026
  3. 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: 21 June 2026
  4. 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: 21 June 2026
  5. How To Use Vaginal Oestrogen Cream – Menopausal Hormone Therapy: What Is Vaginal Estrogen Cream? 07 May 2026. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/how-to-use-vaginal-oestrogen-cream-menopausal-hormone-therapy/ Accessed: 21 June 2026
  6. How To Use Vaginal Oestrogen Cream – Menopausal Hormone Therapy: What Is Vaginal Estrogen Cream? 07 May 2026. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/how-to-use-vaginal-oestrogen-cream-menopausal-hormone-therapy/ Accessed: 21 June 2026
  7. How To Use Vaginal Pessaries – Menopausal Hormone Therapy: What Are MHT Vaginal Pessaries? 07 May 2026. Jean Hailes for Women’s Health https://www.jeanhailes.org.au/health-topics/menopause/how-to-use-vaginal-pessaries-menopausal-hormone-therapy/ Accessed: 21 June 2026
  8. 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: 21 June 2026
  9. Genitourinary Syndrome of Menopause. 2025:2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 21 June 2026
  10. Genitourinary Syndrome of Menopause. 2025:2. Menopause Society https://menopause.org/wp-content/uploads/for-women/MenoNote-GSM.pdf Accessed: 21 June 2026
Topic Last Updated: 21 June 2026 – Topic Last Reviewed: 21 June 2026

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