Vaginal Estrogen: The Menopause Solution Nobody's Talking About

Added: 2026-06-03

[00:00:00]In this week's video, I want to go over something that is really basic, but so important. And that is how to use vaginal estrogen. I'm going to talk about creams, suppositories, a ring, and even some inserts that you can use. This is going to be a great video to make sure that all of your questions are answered and that you're using it correctly. If you don't know me, I'm Dr. Heather Hirsch. I'm a board-certified internist and I'm the CEO and founder of The Collaborative, which is a private telemedicine practice that is open in almost all 50 states. If you would like to learn more, check the description box below. And if you are a clinician and you want to take your expertise to the next level, I also have an incredible series of courses for you to be just as knowledgeable as any other expert and really help your patients thrive through the perimenopause transition, check that out in the description below.

[00:00:51]All right, so there are four main ways that you can use vaginal estrogens. And the reason you would use vaginal estrogen is to treat genitourinary syndrome of menopause, or GSM for short.

[00:01:04]Now, this could be a whole other video, but you don't have to be menopausal, even though the word menopause is in that long phrase, genitourinary syndrome of menopause. You could have a low estrogen state if you just had a baby, if you're in perimenopause, and if you're in menopause. So, don't let the name fool you. If you have symptoms of vaginal dryness, pain with intercourse, or recurrent urinary tract infections, vaginal estrogen is the number one recommended product by the American Urologic Association for recurrent urinary tract infections. And all clinicians definitely agree that vaginal estrogens should be used for vaginal dryness and pain with intercourse. In fact, it is safe for all women. Now, of course, I'm a doctor, but not your doctor, so do talk with your clinician if you think that you are a good candidate for local vaginal estrogens if you have any of those symptoms. Now remember, urinary tract infections are serious and they can go on to cause life-threatening illnesses if that infection gets into the bloodstream. So be sure to talk with your clinician further because I want to be a part of helping your health and keeping you healthy for the long term. Now remember, I said something about safety. Here's an interesting fact. All of the vaginal estrogen products that I'm going to talk about in this video, which are prescription by the way, so again you cannot go and get these without a doctor's prescription, but they do not travel throughout the whole body. So they're not systemic. Systemic means travels through the whole body. These are what we call local vaginal or even sometimes we'll say topical estrogens.

[00:02:44]That means these medications do not travel through the bloodstream, so they don't increase your body's serum or blood levels of estrogen to any measurable degree. And that's why they are safe for the vast majority of women, including even women who've previously been told they can't use it because they've had breast cancer. So if vaginal estrogens have really helped you, comment below because I want you to tell other women who are watching this the success and the effectiveness that you've had from your treatment. All right, I'm going to start off with the most what I think is efficacious and I'll tell you why in a second option, which is the cream. There are two main types of creams that you can get or two formulations I should say. The first is your bioidentical estriol cream. The second is called Premarin. This is where conjugated equine estrogens are made into a cream that you can apply vaginally. Two different formulations essentially. Now, in head-to-head trials, is one better or more effective than the other? I have seen many patients get great results from both.

[00:03:45]It's probably just more important to go with whichever your insurance will cover. Now, the great thing about the cream is it's going to come in a tube, almost like a tube of toothpaste. And it also comes with an applicator. Now, many doctors are given the learning instructions that the starting dose is about for Estrace cream, 1 to 2 g to be put into the vagina twice a week. So, you would just take that applicator, fill it up to the 1 or 2 g mark, and then just like you may have inserted a tampon when you are menstruating or if you are still menstruating, you just pop it right into the vagina. It kind of goes up and it does its thing. Now, Premarin cream, the typical instructions are about 0.5 g two times a week. Why less? Well, because it's just a little bit more effective even at those lower doses. So, that's the way it is most often written from a clinician. However, in this video though, of course, I'm going to give you all the details about the other benefits of using vaginal estrogens. Now, the first with this cream is that because it is so flexible, you can actually use it on your finger and you can apply it directly to the labia. So, if you are having dryness or pain just on the exterior of that skin, whether you just feel sort of roughness throughout the day or even sitting and crossing your legs can feel uncomfortable, you might need to put some vaginal estrogen right on the exterior, basically on the labia. And you can just apply about a quarter-size amount onto your finger and you can rub it into the tissue. This is something you can only do with the cream because a suppository or a pill or a ring or an insert is not going to allow you that flexibility. And many, many women benefit from using it externally onto the skin. The second thing to know is that you can use this more than twice a week. Now, again, I always am going to remind you I'm a doctor but not your doctor, so please anytime you're making a change, discuss this with your clinician just so she or he is aware.

[00:05:44]But because vaginal estrogens do not travel systemically in any meaningful amount. If you find that three times a week helps the dryness or every other night helps the dryness, I have few patients that even use a little bit nightly. That is okay because we do want to make sure we effectively treat either those recurrent urinary tract infections, that vaginal dryness, or that pain with intercourse. Now, here's another tip before we move on to the suppositories. I have some women that insert it into the vagina because they may have pain with insertion or pain with intercourse, and they use a little bit externally. They do both. You don't have to do one or the other. And so, this can be such an effective treatment and really go right to the source. Okay, and I know I said that was my last tip, but I have one more tip when it comes to the cream. Now, typically the cream will come with one applicator per tube of cream, and some women don't like that.

[00:06:40]And I got you. You can easily go search on Amazon for vaginal estrogen applicators, and for a couple of bucks, you can get a ton of these applicators sent right to your house. Number two is suppository. So, suppositories are basically little pills, and this is very different from the cream because each one comes with its own applicator. So, you're going to insert this just like you would a tampon if you ever did that, and this little tablet is going to go up to the back of the vagina, and it's going to sit, and it's going to dissolve there. Now, it's going to dissolve probably in a couple of minutes, and actually same with the creams. It doesn't take too long for it to dissolve. And the nice thing about the suppositories is they're a little bit less messy. So, the creams, for some women, they find that they're really effective, but they don't like the mess.

[00:07:26]What goes up must come down. And so, sometimes, not so much as the estrogen that's coming out, but the vehicle or the kind of the jelly that the estrogen's mixed in in the cream that can be a little messy in the morning.

[00:07:37]Suppositories, on the other hand, much less messy. However, when it comes to its effectiveness, I find that clinically, meaning with my patients, sometimes they see that the cream is more effective. Probably just because it hits more surface area inside the vagina, whereas the suppositories really are just going to get to the top of the vagina. So, that is the benefit of the suppositories. Most clinicians are taught to prescribe it to be used twice a week. But again, just like with the creams, if you find that you really like the suppository, but you need it Monday, Wednesday, Friday, or maybe even every other night, you can increase the frequency at which you use it to get the benefit and be sure that you like the method in which it's being delivered.

[00:08:23]Because there are many women for whom the cream is too messy, or they don't like the applicator itself. And so, they'll stop using it. If you don't use it, you're not going to get those benefits. So, again, it's really important that you find what works for you, and you still get the effectiveness from your medication.

[00:08:40]The two main names for suppositories are Vagifem, and then the generic is Yuvafem. Both of them are great options.

[00:08:48]Again, go with whatever your insurance covers. Now, before I go on to my next one, I would also like to add here that you can mix and match. I have a patient, she uses the suppositories three times a week, and she uses the Estrace cream.

[00:09:02]She puts that on her finger, and she applies that externally. She didn't like the mess, but she really needed that application onto the labia to help with the dryness. So, you can mix and match these to again, really treat you on an individualized basis and get exactly what you need. Onto number three, there is something called the Estring, or the Estring. I like to say Estring, but that's just me. This is a ring about the size of say a hair tie, and you actually insert this, and it would sit behind the cervix. If you've had a hysterectomy, it can sit behind the vaginal cuff, and it will stay there for 3 months. Isn't that cool? It's a great set it and forget it.

[00:09:40]So, let's say you really do suffer from a lot of these symptoms, but it is just difficult to remember to do something two or three times a week. And trust me, I get it, right? Us women have many things to do and many people to care for. So, if you like the idea of a set it and forget it, the ring is a great option for you. You put it in yourself and then you take it out yourself. Now, every once in a while, I've had my patients have trouble and you can easily go into the gynecologist if you have trouble getting it out. If that is you, do not worry, that happens all the time.

[00:10:11]And then you just reinsert it and it stays there for the next 3 months. Now, the downside is it can be a little bit more expensive. And that is because there is no generic. There's only the brand. However, I always remind my patients to take the price they see and divide it by three because it will last you for 3 months. A lot of my patients ask me, "Dr. Hirsch, can I leave this in if I'm having sex?" Yes, you can. It will not bother your partner and it's not going to get absorbed by anyone else. It has to sit next to a mucosal membrane for a long, long time to slowly get absorbed over those 3 months. And so, you can absolutely leave it in. If you feel like you want to take it out just for your preference, you can put it on like a paper towel or towel. It will not get absorbed or lose its potency and then you can put it right back in.

[00:11:00]Remember, it is not birth control, but it does maybe remind some of my patients of the NuvaRing, which is a birth control ring, very similar, except for the NuvaRing lasts for 3 weeks for birth control and then the Estring lasts for 3 months. The last one on my list I call self-inserts. And actually, there's two of these. One is Innervixy. Innervixy comes in a 4 microgram and a 10 microgram, which is the standard dose.

[00:11:27]So, the four is like an ultra-low dose.

[00:11:29]And you You use the your finger to put these the vagina and then they slowly dissolve. The benefit of Imvexxy is that it's sort of a between of the cream and the suppository. So, it doesn't have an applicator, you use your finger to put it in. It's a little bit less messy, but some women just like this idea better, especially if you for some reason needed to use an ultra low dose, this is where you would get that in this Imvexxy. And then the other one is called prasterone or Intrarosa and this is not estrogen, it is DHEA, which actually converts intracellularly into estrogens and androgens. The nice thing about prasterone is that it comes as a 30-day supply, so you can actually do this one nightly. If just doing something every single night makes you more likely to keep on your medication regimen, then the Intrarosa might be a good option for you. Now, if you're overwhelmed, the vast majority of my patients tend to get the most benefit from vaginal estrogen creams, typically Estrace and the suppositories, Vagifem or Yuvafem. But in this video, I wanted to cover all of your options because research shows that about a third of women don't like the option that they're given. And so, I want to make sure you know there are other options in the portfolio. Now, if you want my free hormone health guide, which is going to go over all of this in detail, so you've got something in front of you, check the link in the description below. I hope you like and subscribe to this YouTube channel, so you never miss a video. And again, check the descriptions below if you want to find ways to work with me, either as a patient or as a clinician who is ready to take your career to the next level. All right, comment below, what else do you want to learn about this topic and I'll see you guys next week for a brand new video. Bye, everyone.