Vaginal estrogen is the most effective treatment for vaginal atrophy and its symptoms: dryness, itching, irritation, pain with intercourse. There are three low-dose, localized (without systemic absorption) estrogen options: the vaginal ring (Estring), vaginal tablets (Vagifem), and vaginal creams (Premarin and Estrace). I prefer the ring and tablets, because the cream is messy to use and the absorption is somewhat more variable. Studies confirm is no significant or noted changes in circulating blood estradiol levels with the ring and tablet; the creams are more variable and therefore more likely to have transient elevations in estradiol levels. I have many breast cancer patients who use these methods.
Women who are candidates for vaginal estrogen often also consider over-the-counter lubricants and moisturizers. Lubricants make sex more comfortable in the moment, but don’t improve or prevent the progression of the atrophy. Vaginal moisturizers give more lasting comfort. Used independent of sex on a continuous basis, usually two times a week, they can help restore moisture to the tissues. The moisturizers can also help restore a more healthy pH, promote elimination of dead cells, and increase moisture in the tissues.
If there are multiple menopausal symptoms, which may include vaginal dryness, systemic estrogen (like Vivelle) might be considered, weighing all health factors in the decision.