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

Position Statement

When may vaginal estrogen be recommended?

On page one in The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract, published July 2022, the North American Menopause Society (NAMS) (now the Menopause Society) note:

“For bothersome genitourinary syndrome of menopause symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended”.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

On page one in Deciding About Hormone Therapy the NAMS 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. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.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 Vaginal Dryness the NAMS include:

“Notes: Compounded vaginal estrogen and testosterone are not FDA 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 Vaginal Dryness the Menopause Society explain:

“Notes: 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

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Links

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  10. Deciding About Hormone Therapy
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  12. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  13. Endometrial Safety of Low-Dose Vaginal Estrogens
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  30. Hormone Replacement Therapy (HRT): Vaginal Oestrogen
  31. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – About Vaginal Oestrogen
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  33. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – How and When To Use Vaginal Oestrogen
  34. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Side Effects of Vaginal Estrogen
  35. Hormone Replacement Therapy (HRT): Vaginal Oestrogen – Using Vaginal Oestrogen With Other Medicines and Herbal Supplements
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  40. International Society for the Study of Women’s Sexual Health: Find A Provider
  41. 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
  42. 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]
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  55. Menopause Treatments: What Works, What Doesn’t – Treatments for Vaginal Dryness
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  59. Menopause: Identification and Management: NICE Guideline [NG23] [07 November 2024]
  60. Menopause: Menopause – Hormone Treatments
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  62. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  63. Mymenoplan.org [My Menoplan, United States]
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  69. Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)
  70. Prasterone for Vulvar and Vaginal Atrophy In Postmenopausal Women
  71. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
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  74. Sheplusfoundation.com [She+ Foundation [formerly The Patty Brisben Foundation of Women’s Sexual Health]]
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  100. Hormone Therapy and Vaginal DrynessWorld 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: 06 April 2025
  2. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Abstract. 2022:1 North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 06 April 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: 06 April 2025
  4. Deciding About Hormone Therapy Use. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 06 April 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: 06 April 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: 06 April 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: 06 April 2025
  8. Vaginal Dryness. 2022:2. https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 06 April 2025
  9. Vaginal Dryness. 2022:2. https://menopause.org/wp-content/uploads/for-women/mn-vaginal-dryness_4e454569-8d3c-4346-a00b-515f46b378c9.pdf Accessed: 06 April 2025
Topic Last Updated: 06 April 2026 – Topic Last Reviewed: 06 April 2025

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