What it is: Natural vaginal estradiol is derived from plant-based sources and replenishes the decreasing estrogen levels in your vaginal tissues caused by menopause. Because it’s identical to the estrogen your body produces, vaginal estradiol is the most effective treatment specifically for vaginal symptoms such as dryness and painful sex.
Vaginal estradiol is different from oral estradiol because it acts locally to treat your vaginal symptoms, with minimal absorption and effect on the rest of your body. In contrast, oral estradiol can treat vaginal symptoms along with other menopausal symptoms that affect your entire body, like hot flashes.
How it works: Vaginal estradiol is applied directly to your vagina, and it rejuvenates your vaginal tissue by increasing moisture and elasticity. It also restores a more acidic vaginal pH. Because it’s applied locally, this method of delivery uses a lower dose of estradiol than pill or patch forms of estradiol. At such a low dose, your body’s circulating estradiol levels are similar to those of postmenopausal women not using vaginal estradiol. This is why it’s not necessary to prescribe progesterone with vaginal estradiol.
What the research says: The North American Menopause Society’s 2017 position statement on hormone therapy says that low-dose vaginal estrogen therapy is the most effective treatment for vaginal symptoms due to menopause. Vaginal symptoms related to menopause are common. Between 45% to 63% of postmenopausal women experience uncomfortable vaginal symptoms, mainly vaginal dryness.
Brand name: Estrace cream; Evernow uses: compounded estradiol cream : 0.1 mg estradiol per gram cream
Range of dosage: 1 gram per vagina daily x 2 weeks when starting, then 1 gram per vagina twice a week. (most common)
Safety Information: If you have a history of breast cancer or other estrogen-sensitive cancers, coronary heart or artery disease, a previous clot or stroke or vaginal bleeding that has not been evaluated by a doctor, estradiol may not be right for you.You should speak to your in-person care provider to determine your best treatment options. To learn more about the risks and benefits of estradiol and to read the boxed warning, see this Estrace safety information.