As estrogen declines with menopause, the tissues of the vagina start to lose their elasticity, thickness, and strength, and the vaginal pH can change. Applying estrogen to those tissues can improve the health of the vagina by increasing blood flow (by increasing the number of blood vessels to the pelvic area) and by increasing the production of collagen. 1 This has been extensively studied, and an analysis of 44 high quality trials revealed that compared with a placebo, estrogen improved all of the following:
The type of estrogen preparation (cream, pill, capsule, ring) did not make a difference. What was helpful was getting estrogen into the vagina - in any form. It is important to note that vaginal estrogen does not go into the bloodstream. Researchers measured estrogen (estradiol) levels in the blood while patients were using vaginal estrogen, and there was no increase in blood levels. Note that vaginal estrogen will only help vaginal and urinary symptoms - not systemic symptoms like hot flashes, night sweats, insomnia, etc. 2
For those with concerns about safety, The Nurses Health Study, WHI-OS and a study of post-menopausal women found no increase in breast cancer risk or endometrial cancer with the use of vaginal estrogen. 3
1. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2018;25(11):1362–87.
2. Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol 2014;124(6):1147–56.
3. Bhupathiraju SN, Grodstein F, Stampfer MJ, et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause 2018;26(6):603–10.