Hormones and HRT
HRT risks & benefits
Worried about HRT risks? Unclear about the benefits? We answer your questions and provide expert advice.
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Medically reviewed by Dr. Liz Andrew
BMS Accredited Menopause Doctor
Reviewed: 26/02/2025 Published: 18/03/2025
An Introduction to Vaginal Oestrogen
Vaginal oestrogen is a low-dose, targeted hormone therapy used to relieve vaginal dryness, discomfort, and urinary symptoms caused by menopause. Unlike standard HRT, it does not carry the same risks and does not increase the risk of breast cancer.
It is beneficial for treating vaginal dryness and discomfort and can also improve urinary symptoms caused by menopause, but it will not help with other common menopausal symptoms such as hot flushes, night sweats, sleep issues or mood changes.
It can be used either alone for vaginal symptoms or alongside other HRT if there are other symptoms present. Unlike other forms of HRT, it can be used long term as low risk and often symptoms come back if it is stopped.
Vaginal oestrogen treatments we prescribe
At Menopause Care, we prescribe a range different vaginal oestrogen options.
The type of vaginal oestrogen which works best for you will depend on your exact symptoms. For women with soreness on the skin around the vagina, the cream can be a good option to soothe the skin. Some women will prefer the gel to inserting a pessary - it is really a matter of preference and your expert doctor can talk through your options.
Benefits of Vaginal Oestrogen
Vaginal oestrogen is a low-dose form of oestrogen that works locally in the vaginal and urinary tissues. Unlike systemic HRT, it does not significantly enter the bloodstream, making it a safe and effective option for treating specific symptoms.
- Relieves Vaginal Dryness and Discomfort – Helps restore moisture and elasticity to the vaginal tissues, making daily activities and intimacy more comfortable.
- Reduces Pain During Sex – By improving tissue health, vaginal oestrogen can ease discomfort and irritation associated with intercourse.
- Supports Bladder and Urinary Health – Can help reduce urinary urgency, frequency, and recurrent urinary tract infections (UTIs), which become more common after menopause.
- Minimal Absorption into the Bloodstream – Unlike systemic HRT, vaginal oestrogen mainly stays in the local area, meaning it is safe for long-term use and suitable for women who may not be able to take full-body HRT.
Vaginal oestrogen is available in different forms, including creams, pessaries, vaginal tablets, and rings. Choosing the right option depends on what feels most comfortable and convenient for you.
Many women notice improvement within a few weeks, but it can take up to three months to feel the full benefits. Regular use is key, as stopping treatment can cause symptoms to return.
Yes, vaginal oestrogen is very safe, even for women who cannot take systemic HRT. Because it works locally, it does not increase the risk of breast cancer, blood clots, or stroke. It can be used long-term to maintain vaginal and urinary health.
Ovestin cream contains estriol, a milder form of oestrogen, and is used to relieve vaginal dryness, discomfort, and irritation. It can be applied both internally and externally, making it useful for women who experience soreness around the vaginal opening or vulva. It may also help with urinary symptoms like urgency and frequency.
Learn more about your treatment options
Book a complementary discovery call with our patient expert Jane James. Jane can help you by:
- Explaining the clinical pathway and how oestrogen patches can be prescribed through Menopause Care
- Offering guidance as to whether you may benefit from hormone replacement therapy (HRT)
- Share personal insight and other patient experiences of oestrogen treatment (non-clinical advice)
- Offering compassionate support and a safe, confidential space to openly discuss your concerns
The basics
Key information about Vaginal Oestrogen
Vaginal oestrogen restores moisture, elasticity, and thickness to the vaginal and urinary tissues by replenishing the oestrogen lost during menopause. This helps relieve symptoms like dryness, discomfort, painful sex, and recurrent urinary infections.
Vaginal oestrogen is a low-dose form of oestrogen applied directly to the vagina. It’s used to treat symptoms of genitourinary syndrome of menopause (GSM):
- Vaginal dryness
- Discomfort during sex
- Recurrent urinary infections
Unlike systemic HRT, vaginal oestrogen stays local and doesn’t significantly affect overall hormone levels.
Vaginal dryness can cause:
- A dry, itchy, or sore sensation in the vagina
- Discomfort or pain during sex
- Increased sensitivity or irritation
- Light bleeding after intercourse
- A feeling of tightness
- More frequent urinary tract infections (UTIs)
Vaginal atrophy is the thinning, drying, and inflammation of the vaginal tissues due to a drop in oestrogen levels after menopause. It’s part of a wider condition called genitourinary syndrome of menopause (GSM), which affects both vaginal and urinary health. Symptoms include:
- Vaginal dryness, irritation, or burning
- Pain or discomfort during sex
- Increased risk of vaginal or urinary infections
- Urinary urgency or frequency
- A feeling of pressure or discomfort in the vaginal area
Oestrogen helps maintain the thickness, elasticity, and moisture of the vaginal and urinary tissues. When oestrogen levels drop after menopause, these tissues become thinner, drier, and more prone to irritation, leading to the symptoms of vaginal atrophy.
Topical vaginal oestrogen refers to any form of low-dose oestrogen applied directly to the vaginal area. This includes creams, pessaries, vaginal tablets, and vaginal rings. It works locally to relieve dryness, discomfort, and urinary symptoms.
No, vaginal oestrogen does not cause weight gain. Because it is a low-dose, local treatment, it does not affect the body’s metabolism in the way systemic HRT might.
Yes, estriol cream (such as Ovestin) can be used externally around the vaginal opening and vulva to relieve irritation, soreness, and discomfort. This is particularly helpful for women who experience sensitivity in these areas.
Some women prefer pessaries (such as Vagifem or Imvaggis) because they are:
- Mess-free compared to creams
- Pre-measured, ensuring the correct dose
- Easy to insert with an applicator
- Less likely to cause leakage than creams
However, creams can be better for treating external soreness around the vaginal opening, so the choice depends on your symptoms and preference.
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