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Estrogen Cream for Vaginal Dryness: A Comprehensive Guide

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What if vaginal dryness just went away? Reality checkā€”it likely won't. But there is vaginal estrogen cream, a hormone-based treatment that can be used to tackle the hormonal shifts that lead to vaginal dryness. Vaginal estrogen cream has been around for decades, and clinical studies show it is effective at treating vaginal dryness. Keep reading to learn everything you need to know about vaginal estrogen cream for vaginal dryness.

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Menopause 101

Before we dive into vaginal estrogen cream, we need to talk about menopause. One of leading causes of vaginal dryness is menopause. Vaginal dryness can appear during times of hormonal fluctuation such perimenopause or breastfeeding. But once your periods stop after menopause, estrogen will remain at lower levels. And this can cause vaginal dryness.

Wondering if your vaginal dryness is related to menopause? Menopause is just one day in a woman's life - the day that you've gone 12 months without a period. However, vaginal dryness can start in the years leading up to menopause. If left untreated, it will typically worsen in the years after menopause. Women spend one-third of their lives after menopause, so it's best to seek treatment sooner rather than later.

Illustration showing the progression of vaginal dryness through menopause.
The percentage of women reporting vaginal dryness increases through perimenopause, menopause, and beyond.

Which estrogen cream is best for vaginal dryness?

Vaginal estrogen cream is available in several FDA-approved formulations. In a Cochrane Review (a reputable medical analysis) all forms of vaginal estrogen were similarly effective.

There are two types of vaginal estrogen cream on the market.

  • Premarin (conjugated equine estrogen). Sold under the brand name of Premarin, this cream contains a low-dose of conjugated equine estrogens. The estrogen in this cream is derived from the urine of pregnant mares. Premarin is FDA approved to treat vaginal dryness. Since there is no generic of Premarin, it can be quite expensive.
  • Estradiol vaginal cream. Sold under the brand name Estrace, this cream contains a low-dose of estrogen in the form of estradiol. Estradiol is considered "bio-identical", but this is largely a marketing term. Estradiol vaginal cream is a generic of Estrace. It's FDA-approved and just as effective as Premarin. If a cream isn't for you, estradiol is also available as a suppository or ring.

How long does it take estrogen cream to work for vaginal dryness?

Individual results may vary. Within about two to four weeks of use, you should notice vaginal moisture start to return to the vaginal tissues. If you're sexually active and looking to ease discomfort during sex, it may take about four to six before you feel totally comfortable again. It may take up to three months before you experience the full benefits of using vaginal estrogen cream.

Benefits of vaginal estrogen cream

  • It helps treat vaginal dryness caused by menopause.
  • No more messy lubricants or moisturizers. Vaginal estrogen works with your body to restore moisture to the vaginal tissues.
  • It can protect your vaginal health from complications related to vaginal dryness - including urinary incontinence, leaking, and frequent UTIs.
  • Vaginal estrogen cream is prescribed in low doses with minimal absorption throughout the body. As a result, women who do not want or cannot take oral estrogen may find reassurance in the safety of vaginal estrogen cream.

Potential side effects

One less serious put potential side effect is yeast infection while your vaginal microbiome is adjusting to the healthy benefits of increased estrogen. Yeast overgrowth is usually temporary as microbiome adjusts, and can be easily treated with medications like fluconazole. Other less serious side effects can include nausea, breast tenderness, or headache.

Any discussion of vaginal estrogen needs to address concerns about safety. Many women are afraid to take hormone-based treatments because of concerns about risk of cancer or heart disease.

Interestingly, vaginal estrogen cream has not been shown to increase risk of cancer or heart disease. This is the conclusion of large clinical studies and is also the expert opinion of professional medical organizations such as the Menopause Society.

If you have a history of breast cancer, vaginal estrogen can be safe - you'll just need to clear it with your oncologist.

Does vaginal estrogen cream get rid of vaginal dryness forever?

Vaginal estrogen cream is typically applied daily for about two weeks, and then twice daily to maintain results. You'll need to stay on a maintenance dose for as long as you wish to prevent vaginal dryness. We like to think of vaginal estrogen cream as a preventative treatment - much like sunscreen or seatbelts. If you stop using vaginal estrogen cream, your symptoms will likely return.

What are some alternatives to vaginal estrogen cream?

The main alternative to vaginal estrogen cream is systemic estrogen such as an HRT pill or patch. However, systemic estrogen isn't for everyone. It's absorbed throughout the body and can lead to an increased risk of cancer or heart disease. Women with a history of cancer or heart disease should not take it. Other treatments for vaginal dryness can include:

  • Vaginal moisturizers
  • Vaginal lubricants
  • DHEA
  • Ospemifene

Your Interlude doctor can work with you to figure out if one of these treatments would be appropriate for you.

Hyaluronic acid serum
Hyaluronic acid is a common ingredient in facial moisturizers. It's also been shown to be effective as a vaginal moisturizer.

How to get vaginal estrogen cream

Vaginal estrogen cream can only be obtained by a prescription from a licensed healthcare provider (including a board-certified doctor at Interlude!).

At Interlude, we only offer topical forms of estrogen and not systemic estrogen. If you're looking for a systemic estrogen like an estrogen pill or patch, we don't offer that here. An in-person provider may be your best bet, since you may require more detailed in-person monitoring.

We're on a mission to make vaginal health approachable and comfortable

If you’re in menopause (or close to it) and experiencing vaginal or urinary symptoms, take our quiz or browse our treatments to learn more about how Interlude can help you.