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Pelvic Health

Vaginal Estrogen Cream How to Use It and Alternatives

Vaginal Estrogen Cream How to Use It and Alternatives

by Dr. Barb DePree, MD

What is Vaginal Estrogen Cream?

A vaginal estrogen cream is a form of hormone replacement therapy (HRT), prescribed to treat vaginal dryness, genital irritation, urinary issues, and pain during sex associated with low estrogen levels during menopause.

In this article, we’ll discuss how to use vaginal estrogen cream, the known side effects, and some natural alternatives that also relieve the same menopause symptoms.   

How Vaginal Estrogen Cream Works

During perimenopause, which typically begins between ages 44-55, the production of estrogen begins to drop as the female body transitions out of the reproductive stage and into menopause. During this stage of life, a drop in estrogen levels can result in a variety of symptoms including:

  • Interrupted Sleep or Insomnia
  • Lowered Libido
  • Hot flashes
  • Vaginal dryness (vaginal atrophy) 
  • Vaginal inflammation (vaginitis) 
  • Mood Swings
  • Painful sex (dyspareunia)
  • Urinary issues
  • Weight gain

While several remedies are used to address the various menopause symptoms, vaginal estrogen creams are used to soothe those related to the female genitals - namely, vaginal dryness, vulvar itching or inflammation, urinary issues, as well as discomfort during sex. 

Read: Is Late Menopause a Good Thing?

When applied to the vagina, estrogen creams absorb into the vaginal skin throughout the day and help to increase natural lubrication to relieve dryness, itching, urinary discomfort, and pain during sex. Estrogen creams also help to maintain the elasticity of the vaginal tissues and prevent the vaginal walls from thinning.  

How to Use Vaginal Estrogen Cream

Vaginal estrogen creams are prescribed by a doctor or nurse practitioner and the amount applied can vary for each woman, according to their symptoms. An applicator is typically supplied with the cream to help with the correct dosage, and your doctor will also designate a timeframe or schedule for when to apply the cream. 

When using vaginal estrogen cream, it is important to follow your doctor’s directions, stick to the prescribed dose, and schedule check-ups every three months to check if your dosage needs adjusting. 

Instructions for Applying Vaginal Estrogen Cream 

Before applying vaginal estrogen cream, check the directions and the measurement markings on the applicator that accompanies the tube of cream to ensure you insert the correct dose in the vagina. 

  • Twist the applicator onto the tube
  • Gently squeeze the cream into the applicator until the correct amount is filled
  • Remove the applicator from the tube and screw the cap back on
  • Lie on your back with the knees bent and apart (or stand with one foot raised on a chair)
  • Gently insert the applicator into the vagina, but never so far that it causes discomfort
  • Slowly press the plunger of the applicator to insert the cream into the vagina
  • Once the plunger stops, all the cream has been inserted
  • Remove the applicator and clean it after each use by separating the plunger from the applicator and washing both with warm water and soap 
  • Rinse both the applicator and plunger to ensure all soap residue is removed
  • Replace the plunger into the applicator and store it away for later

What Happens if You Miss a Dose of Vaginal Estrogen Cream?

If you forget to apply your dose of vaginal estrogen cream, try to take it as soon as possible on the same day. However, if you only remember that you missed a dose when your next dose is almost due, it is not advisable to double the dose and take both at the same time, as this can cause harm to your vaginal tissues. Instead, take the next dose when it is due, and continue with your suggested schedule. 

Side Effects of Vaginal Estrogen Cream

Although most women experience few to no side effects when using vaginal estrogen creams, they do occur for some and the most common are: 

  • Bloating 
  • Breast tenderness 
  • Headaches 
  • Nausea
  • Vaginal itching, stinging, or burning 
  • Redness around the vulva

Other side effects, although rare, include the following:

  • Diarrhea
  • Faster heartbeat
  • Feeling faint or dizzy
  • Fever
  • Hives
  • Shortness of breath
  • Swollen hands, feet, face, or eyelids
  • Painful joints 
  • Unusual vaginal discharge with a slight odor (or no odor)
  • Unexpected spotting
  • Wheeziness

If you experience any of these side effects from vaginal estrogen cream, schedule an appointment with your doctor as soon as you can to check if your dosage needs updating or if the cream could be reacting with another form of medication you are taking. 

Natural Alternatives to Vaginal Estrogen Creams & Other Forms of HRT

Although vaginal estrogen creams are effective in treating vaginal symptoms linked to hormonal imbalances during menopause for many women, the side effects are worrying for some and adversely life-changing for others.

In addition to the side effects, vaginal estrogen creams can only treat vaginal symptoms associated with menopause, like vaginal dryness, urinary issues, pain during sex, or vaginal itching or irritation.

But the creams don’t help to prevent additional symptoms like osteoporosis, mood swings, interrupted sleep, or the weight gain associated with menopause. 

Natural Remedies as Alternative to Estrogen Cream

Below are four effective natural remedies that can help to treat not only dyspareunia, vaginal atrophy, and vaginitis during menopause, but also additional symptoms linked to low estrogen levels during menopause like low libido, mood swings, interrupted sleep, and hot flashes. 

If you are dealing with several menopause symptoms, incorporating all four of the following remedies into your daily routine can produce exceptional improvements.   

Vaginal Dilator Therapy

Vaginal dilator therapy involves using a medically approved set of dilators to gently stretch tight vaginal tissues and improve their elasticity by increasing blood flow to the vaginal muscles. This form of therapy also relieves vaginal dryness and any urinary issues connected to it by improving the production of natural lubrication.

Once the vaginal dryness is rectified, discomfort or pain during sex typically disappears too, allowing women of menopausal age to enjoy a renewed and comfortable sex life.  

Although therapy using vaginal dilators typically begins under the guidance of a pelvic physical therapist, once the patient is comfortable with the instructions of use, it is usually practiced in the privacy of your own home with a set of incrementally increasing-sized dilators. 

Chasteberry (Vitex Agnus-Castus) 

Vitex agnus-castus, also known as Chasteberry, is an ancient natural remedy that has been used for centuries to treat conditions associated with the female reproductive system.

Derived from a dry fruit with hormone-balancing qualities, chasteberry is highly effective in treating PMS and a variety of menopause symptoms such as; hot flashes, low libido, mood swings, pelvic discomfort, and interrupted sleep. 


Although a simple concept, moisturizing the vagina is not something many women think about when caring for the rest of the body. However, moisturizing the genitals with an organically-made cream that is specifically designed to soothe vaginal irritation and dry vaginal skin is a gamechanger during menopause. Enchanted Rose Natural Vaginal Moisturizer comes highly recommended. 


Regular exercise helps to maintain healthy blood circulation in the genital area and also keeps the bones healthy to ward off osteoporosis in the postmenopause years. Bike riding or horseriding should be avoided if the vagina is sore, dry, or irritated, however, brisk walking, hiking, jogging, cross-training, and yoga are highly recommended 3-5 times per week. 


Vaginal estrogen creams are often prescribed to treat vaginal dryness, painful sex, vaginitis, and urinary issues associated with hormonal imbalances during menopause. Although harmless for most women, vaginal estrogen creams can cause unwanted side effects for others and another drawback is that they don’t treat additional menopause symptoms.

As a natural alternative to this form of HRT, female health experts recommend a combination of vaginal dilator therapy, a natural remedy with hormone-balancing qualities called chasteberry, along with an organic vaginal moisturizer and regular exercise. 


Mayo Clinic - Vaginal Atrophy -

Endocrine Society – Menopause -

The Pelvic Hub – Why Use Dilators for Atrophy -

Barbara Chopin Lucks - Vitex agnus castus essential oil and menopausal balance: Complementary Therapies in Nursing and Midwifery -