Estrogen deficiency following the menopause may result in significant changes in the vagina. Painful intercourse, lack of lubrication, urinary symptoms of urgency as well as urinary tract infections are common.
Much has been written regarding the long term risk of oral estrogen therapy. Despite these risks, the North American Menopause Society as well as the American College of Obstetricians and Gynecologists continue to support the use of vaginal estrogen in symptomatic women, when over-the-counter lubricants are not helpful.
A recent study by Joanne Manson, MD, PhD of Brigham and Women’s Hospital in Boston, compared about 53,000 nonusers with approximately 900 postmenopausal women currently using vaginal estrogen. Women using vaginal estrogen had a lower risk of total myocardial infarction (heart attack) and a non-significant lower risk of strokes. No significant differences were seen in the two groups of other major health outcomes including blood clots, breast cancer, ovarian cancer, uterine cancer, and colon cancer. https://www.cardiovascularbusiness.com/topics/vascular-endovascular/vaginal-estrogen-therapy-safe-cvd-patients
Dr. Obron suggests that first, over the counter vaginal lubricants should be tried. However persistent symptoms may be treated with vaginal estrogen with the understanding that a growing body of data is showing a very low risk of long-term problems. Studies have been showing that these low-dose vaginal estrogen products work primarily locally with minimal systemic absorption.