Everything You Ever Wanted to Know About Vaginal Estrogen

Attention everyone with a vagina: If your downstairs is feeling parched and persnickety and definitely not in the mood to party — you’re not alone. Everyone who has a period goes through menopause, and fluctuating estrogen levels can make you feel like you’re in the classic horror film, Invasion of the Vagina Snatchers.

But before you decide you don’t even know who your vajayjay is anymore and donate your “nice” underwear to science, know that there are treatment options that can help with vaginal dryness and thinning, loss of elasticity and painful sex (also called genitourinary syndrome of menopause or GSM).

One option making headlines these days is vaginal estrogen therapy. A growing body of research has found that vaginal estrogen creams and tablets are safe for most people — even people with a history of breast cancer.

Read: More Research Shows Vaginal Estrogen Is Safe for People with a History of Breast Cancer >>

This is because local vaginal estrogen only affects the vaginal area — not the whole body like systemic menopausal hormone therapy, which is also safe for most people but may not be recommended for people at risk for certain health conditions like breast cancer.

Most recently, vaginal estrogen made headlines when a panel of experts urged the FDA to remove the black box warning on vaginal estrogen products. The experts noted that the warning cites outdated research that is not about vaginal preparations.

The jury is still out regarding the warning labels on vaginal estrogen, but research shows low-dose creams and tablets are safe for most people and can be life-changing for GSM.

So how does vaginal estrogen work? Should you be Team Cream, Tablet or Ring?

Here’s what you need to know about vaginal estrogen therapy.

​What is vaginal estrogen used for?

Vaginal estrogen is a localized treatment for people experiencing GSM during perimenopause, the time leading up to menopause, and after menopause.

Symptoms of GSM can include:

Vaginal drynessVaginal burning and/or itching Painful sexUrinary incontinence A frequent urge to peeUrinary tract infections

​How does vaginal estrogen work?

Vaginal estrogen can come in a variety of forms, including tablets, creams or even vaginal rings. Depending on the form you’re using, vaginal estrogen can be inserted into the vagina using your fingers or an applicator — think tampon or yeast infection medication.

The therapy works by stimulating the cells of your vaginal and vulvar tissue which increases its thickness and can enhance lubrication.

Vaginal estrogen can also help balance pH of the vagina.

​Vaginal estrogen tablet vs. cream vs. vaginal ring

Research shows vaginal estrogen cream and tablets are equally effective for GSM, but tablets may be more user-friendly than creams.

One study found participants favored tablets because they were more convenient (prefilled applicators) and less messy than the creams.

Vaginal estrogen tablets

Commitment: Insert once a day at the same time for two weeks, then twice a week (or as often as prescribed) for as long as needed How to use:Stand with one leg up on an object like a chair or lie down on your backInsert the applicator about ⅓ -½ of the way into your vagina Press the plunger until you hear a clicking soundDispose of the applicator

Vaginal estrogen cream

Commitment: Insert once a day at the same time for two weeks, then twice a week (or as often as prescribed) for as long as neededHow to use:Fill the applicator with the prescribed amount of creamLie down on your back with your knees up to your chestInsert the applicator into your vagina and press the plunger to release the creamClean the reusable applicator with soap and waterIf you can, insert cream before going to sleep to prevent the cream from falling out

Vaginal ring

Commitment: Rings are inserted in the vagina and removed after three months. A new ring may be needed after the three months depending on your treatment plan.How to use:Wash and dry handsStand with one leg up on an object or lie down — whatever works best for youHold the ring between your thumb and index finger and press it together to make an eightWith your other hand, hold the skin around your vagina openPut the tip of the ring into your vagina and push it in as far as you can using your index finger. Note: There’s no right way to do it, but the ring is less likely to fall out when it’s in your vagina as far as possible.

Read: 5 Minutes With: Ashley Winter, M.D., Talks Urology, Sex and All Things Vaginas >>

​Side effects of vaginal estrogen

Low-dose vaginal estrogen typically has few side effects. But they can happen.

Common side effects of vaginal estrogen cream and tablets can include:

Burning sensation in the vaginaVaginal irritation/itching

Rare side effects of vaginal estrogen cream and tablets can include:

HeadacheSore breastsHair lossVaginal spotting or dischargeBloating Nausea or stomach cramping

​Vaginal estrogen and sex

Many people take vaginal estrogen to help with painful sex. But before you get busy, make sure you’re leaving enough time between application and getting it on. Estrogen can be absorbed by male partners during sex, so it’s a good idea to wait a day or at least 12 hours to let your body absorb the estrogen.

Limited contact with vaginal estrogen cream/tablets shouldn’t cause any side effects for male partners, but one older study found prolonged exposure can lead to feminine changes. And if your partner is absorbing some of the estrogen, you’re not getting the full dose you need.

Also, avoid using latex condoms, diaphragms or cervical caps for up to 72 hours after using vaginal estrogen creams. Certain oils can weaken the rubber.

​Team vagina

If you’re experiencing symptoms of GSM, talk to your HCP about treatment options. You don’t have to suffer — vagina care is healthcare.