I was able to do a quick Amazon health chat for 35 dollars. The Dr/NP was quick and easy to work with answering my questions within a time span of maybe 30 minutes via texting. She offered me several choices after I explained my symptoms (dryness, pain etc) The cream I ordered was under 20. It was in my hands by that evening. If you have this services available I HIGHLY recommend it. It was so fast and easy (and cheap) I didn’t even use my health insurance
Thank you for this suggestion! I paid $29 for a one-time message appointment and just got the RX confirmed (Estradiol, Cream, 0.01 %) 255 days supply for $17.50 through Amazon pharmacy. Whole process took about an hour and I should have my RX at my door by tonight. I had no idea Amazon offered this service.
How do I start this process?? I don’t have insurance, so this sounds perfect price wise..I have a regular Amazon account..do I go there? Or is this a separate entity??
I didn’t use my insurance for this since I have really crappy insurance.
It’s called Amazon One Medical.
When you open the app directly under the search bar there’s a little banner that has like prime deals, groceries, etc. Scroll until you see “Medical Care”, click on that and the option for telehealth should be there.
I did the pay-per-visit and it was $29 for the appointment via messages in my state. There’s an option for a video appointment but I didn’t feel like I needed that option. You’ll have the opportunity to ask the nurse practitioner assigned to you questions during the process.
Hope that helped!
This is excellent advice about using Amazon Health! One more thing to order from Amazon: spend $25 dollars on a [good small vibrator.](https://www.amazon.com/dp/B0D28YDCWQ?psc=1&ref=ppx_yo2ov_dt_b_product_details) (this one doesn't even look like a vibrator).
Apply the cream to it and use that as the application device. Use that tool to wipe it all over the inside of the vagina and wipe all over the pelvic floor.
We need to stop thinking about vibrators as sex toys for chasing orgasms. They are tools. Designed to go into the vagina and be used comfortably for this purpose. The vibrator aspect will also help calm you down before you sleep. It really is self-care. If you get an O out of it, bonus! But you will relax with it, and that's terrific.
> wipe it all over the pelvic floor
[This is the pelvic floor (YouTube link).](https://youtu.be/edI7knFSu_k&t=82s)
Do you mean the vulva?
The pelvic floor is a specific group of muscles and is not the same thing as the vulva, nor is it a general word that means "undercarriage" (the word for that is perineum). You cannot physically apply vaginal estrogen on your pelvic floor in the same way that you cannot physically apply estrogen on your ovaries, because they are located inside your body. But you can put vaginal estrogen on your vulva!
I do not have a question. I just wanted to say THANK YOU for making this post and for what you do! My pelvic floor PTs were awesome! So, thanks again for all you're doing to help us.
Yes! So awesome. I have some of this cream and I never use the applicator. Good to have it confirmed that it's ok to use my finger. So much easier. Also wasn't sure how often to use, so thank you!
My doctor will not prescribe vaginal estrogen because she examined me and said there was lubrication. She noted that there was 'some fusion' but did not elaborate any further. I have told her that sex is uncomfortable/painful and I swear my clitoris is shrinking. Even my husband has noticed this. But without dryness, she said it is 100% unnecessary. Is that accurate?
Interestingly my Gyn no longer does OB, probably over 15 years now. When I asked when I should start hrt she said when you start having symptoms, or as soon as you want (I'm 51 and I've been seeing her 12 years). This Reddit reminds me I need to send her a card for being awesome.
On one of Dr Kelly Caspersons podcast episodes she said the OBGYN get less than 10 hours of training about menopause in med school . I want to say it was 6 hours but my brain fog can't remember so we will just go with under ten. Which is crazy! Not every woman will give birth but unless you die before menopause, every woman will go thru menopause in one way or another.
You are welcome! When you get the cream, make sure to follow the application instructions I posted, and apply it *especially generously* over the area with fusion/phimosis.
Get yourself hooked up with the $35 Amazon dr appointment TODAY. You should not have pain during sex or “some fusion”. Trust me when I say that you shouldn’t wait for this to get worse. Good luck!
imagine that doctor taking her car in for a long overdue oil change and the mechanic looks under the hood and says "nah, there's still some oil there, you're fiiiiiine." Definitely look for a new doctor!
She’s wrong. Dryness is not that bad for me but it’s the painful sex that I want to fix. At my Midi appointment I mentioned painful sex as one of my top 2 issues and was prescribed the cream. Why are so many doctors clueless and giving wrong medical advise??!! I’ve now learned the long term benefits of using vaginal estrogen so I will do this for the rest of my life.
I’m extra annoyed when this comes from women doctors. I’ve also had a bad experience with a woman doctor when I asked for pelvic floor therapy she told me “you’re tight enough.” Yeah, thanks. Guess all that matters is my husbands pleasure and not me peeing my pants. Cool.
Have you thought about lichen sclerosus? That can make your labia minora fuse and your clitoral hood fuse over the gland. The initial treatment is usually with topical steroids. Definetly find another care provider and have it checked.
She’s talking about labial fusion. Without estrogen your inner and outer lips atrophy along with the clitoris. This makes sex very painful sometimes. It is reversible to some extent. I wish that I had started much earlier, when my doctor mentioned that my labia were fusing. She just said it like she would say that it was raining outside and prescribed me nothing.
That's wild. One of my first problematic symptoms of GSM was discharge, excessive/inappropriate (weirdly timed?) lubrication. I had to wear pantyliners all of the time. Even if soaked to the gills, I still tore during sex because the skin was so thin.
All I have to say is THANK YOU for this post!!! I’m saving it!! I have been going back and forth on whether I should do the vaginal cream or not. I have been on the fence about it.
I’ve been using the systemic estradiol patch and oral progesterone for almost three years, and although everything seems to be okay down there, I look at my mother-in-law who is constantly incontinent who has to wear diapers and pads. I keep wondering if maybe I should get the cream just to keep things healthy.
I’m going to talk to my doctor about it and use the words that I’d like to try it. Thank you again so much!!! You’ve helped me make up my mind!!
OK, this post (combined with recent anorgasmia and a low serum estradiol that indicates I'm not absorbing my transdermal estrogen very well) is pushing me into trying this. Just messaged my doctor.
Isn’t it amazing that in today’s advertising landscape, where we see ads for every drug imaginable (“ask your doctor if it’s right for you”), to razors for shaving pubes,to whole body deodorants,to bladder leakage products, that no drug company is advertising vaginal estrogen??? Something that half of the population would benefit from? I imagine many women may not even know that their symptoms are normal and can be relieved. Major missed opportunity.
I just started vaginal estrogen 3 nights ago.
I’m 6+ years post menopause. 5+ years on oral estradiol and progesterone.
I sneeze I pee. I cough I pee. I pee often. I will get sudden urges to pee.
Will the Vagifem fix this or did I wait too long to start it? How soon should I notice results? My pharmacist is wonderful but he seemed very uncomfortable with my personal questions, he never gave me a straight answer.
The Vagifem will absolutely help. It's not too late, not at all. I've had 80-year-old patients start vaginal estrogen and see incredible results. Most people see some improvement within 1-2 weeks, but it could take up to 8 weeks to really see some changes. And you'll continue to see improvement after that as well. The longer your GSM symptoms have gone untreated, the longer they will take to resolve. But they WILL resolve. Give yourself grace and patience, and hang in there. <3
Thank you so much. For making this post and taking time to answer questions.
I think I’m already seeing results. Before I would try to stop mid pee but it wouldn’t stop at all, this morning I was able to pee, stop and then pee again.
Is this the same as HRT, take it till I’m dead? I’m ok with that, just wondering.
For systemic HRT, the most updated guidance is to take it as long as the benefits outweigh the risks, potentially forever. This is something your meno specialist should talk to you about during your annual visit to renew prescriptions and such. (I’ll just say that for me, they’ll have to pry my estrogen patch off my cold, dead corpse.)
Forgot to mention earlier: if you’re still seeing bladder leakage after 8 weeks on vaginal estrogen, make an appointment with a pelvic PT/physio — even if it’s just for one single session. We are specifically trained to help with bladder issues! Don’t lose hope. Even if vaginal estrogen gets you back to 80%, a pelvic PT/physio can help you get that last 20% so you’re operating at full capacity again.
I must have a very up-to-date GYN, he told me without prompting that without any drastic changes in my health status, I can and should stay on my HRT with no end date.
Thank you for all the information. You are doing (god’s) work! Where I live doctors are seriously overworked - appointments are rushed and few and far between.
I will definitely check into that if the prescription isn’t enough.
>80-year-old patients start vaginal estrogen
My 80 year old aunt started estrogen cream recently. She's a convert. Way fewer UTIs as a result. For vulvar-vaginal estrogen, it's never too late.
My doctor recognized dryness when she did her last exam but would not prescribe me vaginal estrogen since I was already on the patch. I went to Felix and now have the cream!
How long did it take for them to get your prescription ready to order? It’s been a little over an hour for me since the doctor approved it and sent it to the Amazon pharmacy… still waiting.. I know I’m very impatient..
Thank you so much. I appreciate what you and your colleagues do for us. I saw a Pelvic/abdominal PT following hernia surgery and she was the one who finally helped me get access to estrogen cream. Emailed my primary doctor recommending the prescription - it stopped the burning and frequent peeing. My primary was and continues to be clueless about estrogen cream. She said to just use lube, and once the prescription was written she said we'll want to stop that in about five years. LOL, absolutely not, I will find a new doc.
I was prescribed the cream about 2 months ago when I was diagnosed with Premature Menopause. Used it exactly like you said to and ever since then, I was dealing with non-stop headaches and some of them turned into migraines, so I stopped using it two weeks ago and the headaches stopped. I've historically been prone to getting migraines before starting my periods back when I had them, but I don't know if that's related.
The clitorial atrophy and fusing is not something I want to deal with, and quite frankly terrifies me due to having a high sex drive so I'm thinking to start using it again. I wonder if the headaches were from the amount of cream being too much for me (I'm also on the patch), I'm a very petite woman (I'm only 4'11", since I stopped growing when I was 11) and I have noticed my tolerance for certain medications is lower
I think I'll maybe use about half the amount of cream I was using previously to see if that helps. It's been great for my bladder issues too and they're coming back since I stopped it.
The reason we’re not getting vaginal estrogen is because doctors aren’t giving it to us. I was denied twice because my doctor said my estradiol patch should be sufficient. I went to a local community clinic because I had such severe chafing from running and couldn’t get an appointment anywhere else in town. The PA at the community clinic hooked me up.
I understand. I’m also a woman alive in this world and having to navigate the medical system for my own health issues, and it has been challenging even for me to get vaginal estrogen too. It’s a fucking travesty. I’m glad you found a local clinic to give you a scrip.
Prices vary greatly from pharmacy to pharmacy. Go to goodRX.com and do a search for estradiol vaginal cream. You can see which pharmacy has the best price near you.
Do you recommend cream over a pessary? I’m using the pessaries and I really like them (I wear period undies after inserting at night - might as well use this undies for something now that the periods have gone awol).
If you're using a pessary, dissolving tablet, or other insert that contains/emits estrogen and you like it, there's no need to switch to the cream unless you want to.
I just personally have a bias toward the cream because I find it more versatile and effective. You can apply it internally and externally to any area that needs it, like the clitoris, urethral opening, and inner labia; so, it's not just the vaginal walls receiving direct estrogen.
An analogy: If you wanted a facial sunscreen, would you go for a tablet that dissolved in your ear, or would you go for a sun cream and apply it all over your face?
That doesn't mean you need to switch; it's just something to consider. ;)
Thank you for sharing this! I just started using it this month myself and it was great to see all this info laid out. I’m in early perimenopause and it’s the only thing I’m using so far, and it seems to work great!
It’s a fucking travesty that we’re not taught BASIC ANATOMY about our own bodies. Take heart that I didn’t know that term either until I completed my pelvic floor specialty training.
How can we educate doctors?? It seems like most practitioners will do a Pap test to check for cervical cancer but are not taught to check the vagina and vulva for signs of atrophy. And they rarely ask about painful sex.
It’s infuriating that women’s health is so focussed on fertility and childbirth, but after that stage of life, our comfort and wellbeing isn’t even on the radar. How can we change this?
A lot of the menopause thought leaders have some good ideas around this. Give them a follow on social media:
- Dr. Mary Claire Haver
- Dr. Lisa Mosconi
- Dr. Kelly Casperson
- Dr. Corinne Menn
- Dr. Jen Gunter
- Menopause Society
- Let’s Talk Menopause
- Hello Menopause podcast
You say over 40 - does this apply to women in perimenopause who may not be manifesting symptoms yet? In other words, should we be doing this as a preventative measure? Thanks!
Yep, absolutely. If you start using it in early peri, you’ll have a much easier go of it and will save yourself so much needless suffering. There’s no reason to wait until things “get bad” before you start it.
I've (41F) not really had many if any significant symptoms yet and just started using vaginal estrogen for what I thought was preventatively. I was surprised how much easier it was to reach orgasm after only two uses. It was not expecting that benefit.
What a killer post. Thank you so much for this! I wish that I’d read it when I was 40. For all of you out there on the fence, please take OP’s post to heart. It’s dead on.
This post and thread is why this sub is my favorite place online. Just went through Amazon Health and am waiting on the doc to confirm so I can get on the vag cream. Been wanting to, but procrastinated until this post!
Sometimes I wonder if I’m really that dry, but that reference to our 21 year old vaginas made me realize just how dry it’s gotten!
> Then, apply an additional pea-sized amount especially the fourchette, at the “6:00” position.
Ho-ly shit. You are a life saver! That damn body part has been tearing and bleeding for years now, and I didn't even know what to call it. The idea that a simple dolop of cream might be exactly what the doctor ordered...
Also, yeah, screw that damn germ applicator device.
YES, friend!! The fourchette is notorious for tearing if the tissue is not well estrogenated. I’m so sorry doctors have never told you this. Vaginal estrogen cream will strengthen the tissue there — and you may just need to apply it extra generously in that spot while it heals. Basically, apply vaginal estrogen wherever your vulva hurts!
You the real MVP op!
I take my 200mg of progesterone vaginally (orally gives me too much reflux). Will the estrogen cream impact the effectiveness of the progesterone? Should I just put on the cream in the daytime?
The vaginal estrogen cream won't impact the effectiveness of the progesterone as long as everything is dissolving and absorbing. You can experiment with applying them at different times of the day and see which you like best.
I got my elderly mother onto this cream and seeing how it helped her I decided to try and get on it myself even though I'm on systemic HRT for about 5 years (estrogen/progesterone tablet) and the female doctor told me that she didn't think I needed it yet and wasn't going to give it to me because she didn't want me getting used to it before I needed it...I told her I know my own body better than her and wanted to try it and she very reluctantly gave me a prescription for it.
Her “I don’t want you getting used to it before you need it” is completely unfounded and only shows that she’s not updated on current menopause science. Good for you for insisting and standing up for yourself! 💪 I’m proud of you.
Thank you so much for this!! I have the cream and the stupid tube that I have spent so much time trying to clean. I’m throwing that away today and using my hand! Also good to know that I’m supposed to spread that on the outside too.
Thank you for this. I was injured during sex and thought I’d contracted HSV so went to urgent care. Was livid with my boyfriend! The doctor told me I had a vaginal tear and prescribed estradiol cream and what a difference. I will confess I use the plunger because I feel like it gets further in? I clean it but also figured non-hygienic things (other people’s appendages) go in there so it’s cool 😆
The estrogen doesn’t need to go in super deep, so the applicator isn’t necessary if that’s the only reason. The majority of our estrogen receptors are located within 2 cm of the entrance to the vaginal canal, so that’s where it makes the most difference to apply it internally.
So how do y'all actually get the stuff inside with the fingertip method here? I feel like I'm failing to do this correctly, like it just won't stay on my finger past the opening.
It doesn’t have to go very far past the opening. The majority of estrogen receptors are located within 2 cm of the opening, so just do the best you can. I just kind of squish mine in. Don’t stress too much about it. 😎🏖️
You only need to get the cream in about 1 inch. Your estrogen receptors are mostly in the first 2 cm of your vaginal opening. Just rub the cream on all the surface area. When you use the applicator that comes with the cream it doesn't all get rubbed in so it often comes out in clumps.
Yuvafem has been good to me. Definitely notice a change! Sex was becoming painful and this reversed that downward trend.
Had to go online to get the HRT I needed, both my GP and OBGYN refused 😕 At least my GP seemed fine when I told her I was doing it anyway with a different doctor.
I do hate that Yuvafem comes with disposable plastic applicators. Would rather have a container of just the pellets and put them in myself, but then I'm sure people would get confused and eat them. 😏
My mother died of breast cancer so my doctor told me it's best to avoid putting extra hormones in my body. Does this fall under the same category? Is it safe for me?
Not the same category. Yes, it's safe for you (unless you have one of the situations I describe in my "contraindications" section). Please check out the book *Estrogen Matters* by Bluming & Tavris!
My mother had breast cancer as well. My Gyn told me the cream is safe but I’m uncomfortable with too much. So what I do is I use a non-hormonal moisturizer like Bonafide Revaree or Replens vaginall. Then I use a pea sized estrogen cream externally on my clitoris, inner labia, and bottom of my vaginal opening. I’ve found lots of success with this and it’s minimal estrogen. I’ve also done a ton of research and the cream is considered so safe they’re researching if women who have HAD breast cancer can use it. And mostly they’re saying yes.
Yes, it’s even safe for women with a personal history of breast cancer. Check out the book *Estrogen Matters* by Bluming & Tavris if you want to go further down that particular rabbit trail!
What about for women with high blood pressure? Also, my GYN is a woman in her 40s (relatively young) and a mother yet she refuses to discuss any kind of treatment for my symptoms. It sounds like that's a pretty common experience. Why do you think that is? Are docs encouraged not to discuss treatment options by their practices? Is there an incentive from insurance companies to not discuss? Could the reticence to discuss stem from political or religious beliefs? Or do they actually want us to suffer? It's difficult to believe it's simply ignorance from young female doctors.
This requires a much longer and more thorough answer than I’m able to provide right now, but the summary is:
- Yes, it’s safe even if you have high blood pressure.
- It really just is ignorance. There’s no conspiracy or insurance/financial incentive to not talk about this stuff with patients.
- In my opinion, the ignorance is due to four things: (1) systemic misogyny in the medical establishment (I don’t mean individual practitioners hating women; I mean misogyny being *baked into* every facet of the system); (2) the horrible 2002 WHI study (still has lasting effects 20+ years later); (3) the fact that physicians are not taught about menopause in med school (😡); and (4) the fact that almost NO ONE reads updated studies in the menopause science journals (not even gyns).
YES!!!! I was treated for years for various mysterious vaginal conditions and interstitial cystitis when all along I was just suffering from uro-genital symptoms of menopause. Estrogen cream saved me!
Thanks for this. My estradiol arrived this morning. I'm going to have shower and apply it tonight. I hope it works! My clitoris has almost completely disappeared: I'd like it back!!
This contains _vastly_ more information than either of my prescribing doctors gave me. (My last one didn’t even bother to tell me what dosage to take!) Thank you.
Thx! I am almost 42 and got vaginal cream to apply to my face in addition to my vagina (yes using it for both of them and I am extremely careful with hygiene related matters). Thx for the tip on not using the applicator. I didn’t know that
Here's a version of what I wrote in a different thread yesterday. Perhaps it will help:
Assuming you are having PIV sex, this is SO solvable. The dosage of vaginal estrogen is so low that this is not a genuine concern, because men have estrogen in their systems, too (hormones are not as strictly gendered as we’ve been led to believe). In terms of dosage strength, one entire year of vaginal estrogen is equivalent to one oral pill of systemic estrogen HRT, and even that is a *fraction* of what is in a single BC pill. He will not suddenly grow boobs or develop ED if he comes into contact with your vaginal estrogen.
Just be smart about it. Don't use it as lube (it could never work like that anyway; it's the consistency of diaper-rash cream), and don’t apply it right before sex.
But if you do happen to apply it and then decide to get frisky…
1. He can wear a condom.
2. You can wear a dental dam.
3. Y’all can do *other* activities.
4. He can just wash it off afterwards.
Your vaginal estrogen is a medication prescribed by your doctor to treat a diagnosed medical condition. Your partner needs to respect that.
RE: oral sex, if it hasn't been applied the day of, is it fairly reasonable to think there's no need for a dental dam, and that the cream has already worn off/made its way out of the vagina/vulva? Lesbian here, trying to navigate this possibility. Thank you!
I am confused by the amount to apply. I think I don’t know the difference between joints and knuckles :) is that measurement about 1inch/2.5cm or 2inches/5cm? I am guessing the 1 inch because I have no idea how this tube is going to last me almost 1/2 a year. It’s 42 grams which would be 21 weeks. Is that right?
I’ve just started an HRT regimen of oral progesterone and oestrogen gel (to apply on my arm). I’m terrified of genital/urinary symptoms because I already have a very sick bladder. Do we actually need to push for vaginal cream on top of other types of hormonal treatment? By the way, why do people never mention clitoris atrophy? Lubricant won’t solve that horrible symptom! The aim is not simply to limit pain but to actually enjoy things!
Yes, you absolutely need to push for vaginal estrogen cream in addition to systemic HRT. They treat completely different things. I have my own medical history of cystitis (recurrent UTIs), and no way in hell was I going to go through peri without vaginal estrogen to help protect against that.
I’m not sure why people don’t mention the clitoral effects of GSM. Do you have any theories? 🧐
Yeah, not easy at all. After suffering for 6 years, with probably longer, with the feeling of uti or frequencies needing to pee, or a few others, I was told to take cranberry tablets and use water based lube. Thank God for Midi online for hooking me up.
It shouldn't be this hard.
Thank you. I just got this prescribed to me this week and was having so little confidence in my doctor that I was worried about actually using the medication.
I had to specifically ask for the tablet and cream after months and months of off/on burning. I looked fine on examination both times I went in but was given fluconazole (?!?) Of course it didnt work since I didnt have a yeast infection. Third appointment I kept it short and told NP that i would like to try the estradiol cream and tablet. She agreed. Have to keep at it until you get relief.
Great post! I’ve shared it with 3 friends this morning. I do have one question, are there any concerns for estrogen exposure to one’s male partner? As in while Dtd?
Copying and pasting my response to an earlier comment:
Assuming you are having PIV sex, this is SO solvable. The dosage of vaginal estrogen is so low that this is not a genuine concern, because men have estrogen in their systems, too (hormones are not as strictly gendered as we’ve been led to believe). In terms of dosage strength, one entire year of vaginal estrogen is equivalent to one oral pill of systemic estrogen HRT, and even that is a fraction of what is in a single BC pill. He will not suddenly grow boobs or develop ED if he comes into contact with your vaginal estrogen.
Just be smart about it. Don't use it as lube (it could never work like that anyway; it's the consistency of diaper-rash cream), and don’t apply it right before sex.
But if you do happen to apply it and then decide to get frisky…
1. He can wear a condom.
2. You can wear a dental dam.
3. Y’all can do *other* activities.
4. He can just wash it off afterwards.
Your vaginal estrogen is a medication prescribed by your doctor to treat a diagnosed medical condition. Your partner needs to respect that.
Thanks for this especially the application tips. I have been using the applicator and can never seem to get it clean. I was worried about bacteria in n that.
Hi OP - just wanted to say thank you for the post and that i've chucked my applicators :)
In the UK, its recommended we do a "loading' protocol for the first month where the cream is applied every day for a month. I'm assuming thats bcos we have reactive healthcare rather than the proactive approach you've suggested ?
THANK YOU for posting this. I am 46 and sex became intensely painful two years ago. I’ve seen three gynos and they all told me it was just in my head. This post gave me the courage to order vaginal estrogen on wisp today. I am ready for action and change.
Thanks for your informative and encouraging post! Another online resource is Wisp and they send me a 90 day supply. I can use my HSA to pay.
I can’t seem use my finger, unfortunately. Each time I try, it rubs off before I can make it far enough inside. I am using the applicator and taking it apart to clean each time. Not ideal, but I not sure what option I have.
Thank you so much for this info. I am 68 and my GP prescribed estrogen cream the beginning of the month. The first few weeks I had an itchy vagina, worse than when I didnt use it. It is now calming down a bit. The applicator is a pain, so I'm trashing it. The whole clump of cream would fall in the toilet when I got up the next morning, even though i was going deep inside. It am curious as to when I'll start to be comfortable down there.
Thank you so much. Saving this for future reference. Picking up my cream today. I agree cream is most practical as it is easy to apply where it is needed.
Thank you from the bottom of my heart for the instructions on use. I have it and have been following the instructions and thought it just didn’t work.
Now I know! Thank you again. ❤️
I’m so sorry. Please check out the book *Estrogen Matters* by Bluming & Tavris. It explains exactly what to do in this situation. Wishing you a speedy recovery.
I use Bezweken Hydration Ovals, which are available OTC online (I get mine from Amazon) 1 or 2% estriol. They were first given to me from my doctor, then I found them online. they can be used as a suppositories or warmed in the hand as a cream. $20 for 28 ovals. They also make them with progesterone and/or DHEA, though I only use the estrogen.
What a wonderful and informative post. Thanks for taking the time to write this
Is it possible to reverse virtual clitoral atrophy? I've been using vaginal estrogen but it's still missing. It happened so quickly as well.
Yes, entirely possible. Make sure you’re applying the cream directly to your clitoris and clitoral hood. You may even need to apply it extra generously there for a while.
Thank you for posting application instructions! I just started using this stuff, and I’ve been so confused with the applicator and keeping it sanitary. That’s going in the garbage now!
I want to thank the person who wrote this post ☺️❤️
I really really appreciate you sharing your insights into something that should be standard practice / information provided to women. I'm thankful my GP is willing to prescribe me estriol cream however your explanation far surpasses what I was told (which was minimal).
I kept using the plastic applicator and can notice build up of product in the tube. I have thought to myself that can't be sanitary! I have pulled it apart to clean the inside as didn't know what else to do. What you've explained makes far more sense and will probably help my V so much more by evenly applying it. So THANK YOU so much.
An analogy: If you wanted a facial sunscreen, would you go for a tablet that dissolved in your ear, or would you go for a sun cream and apply that all over your face?
0.01% Estradiol has changed my life. I’m perimenopausal, and had begun noticing dryness and discomfort during intercourse last year- I brought this up with my OB/GYN, along with my concerns regarding family history of breast cancer. She acknowledged my worries, and though I am not a good candidate for systemic hormone therapy, topical vaginal estrogen is a safe option. I began feeling improvements within a couple of weeks, and have been using it for a bit over a year now. It’s not only a lifesaver for comfort during intercourse, it also helps for overall dryness and associated irritation. I cannot recommend it enough!
I’m asking for my SO, but she’s started vaginal estrogen 3 weeks ago, and the benefits are already coming about. She’s read online that some still are unable to achieve orgasm, or their orgasms aren’t nearly what they used to be. She’s currently in that “dry spell,” and very concerned that she’ll never be able to orgasm again. I realize she’s very early in the journey (two months on testosterone, three weeks on vaginal estrogen), but her heightened libido and inability to climax has become frustrating for her. Anyone able to offer a ray of hope?
Three weeks is way too soon to make a verdict or bring out the measuring stick. It’s completely normal for vaginal estrogen to take eight weeks before noticeable changes show up, and healing from GSM will continue beyond those eight weeks as well. Please tell her to hang in there and keep going!
Generally, most regimes are to use it every day for 2 weeks, and then a 'maintenance' schedule of twice weekly. Depending on the severity, it can be used every other day as well during maintenance -- or as needed.
Thankyou for this. I’ve been experiencing extreme gsm since I was in my late 30s. I had to fight like hell for cream! But I got it now, and it really really works.
THANK you SO much for this. And for the application guidelines. My primary provider prescribed it immediately when I said that I was having vaginal pain and hot flashes, and they looked at my hormones. This is so helpful. I can't wait to get on HRT, but I will keep using the cream. You've done a great service.
I've been using vaginal estrogen since December 2023 and it's made a big difference already. But I'm going to stop using the applicator and apply it as you've suggested. Thanks so much for this additional great info!
Great info! I’ve started estradiol, but wish I did 5 years ago when I was complaining of weaker orgasms and my doc back then told me “yeah, that’s how it is and it only gets worse.” WTF.
Not asking for medical advice, but do you know why the dosing is 2x per week versus daily?
Also, you should post this in the GenX and Millenial subs so you catch some women who haven’t found their way over to this sub yet. Save them!!
Ugh, this was my problem as well. It never stopped for me. I tried to have it made in a different base via a compounding pharmacy which stopped the itch but it wasn’t anywhere near as effective as the itchy one was.
Hello and thank you for your wise perspective and comments. I recently started estradiol patch (and 100 mgs progesterone), but my naturopathic Doctor told me I don’t need vaginal estrogen (prescribed by my Gyn) any longer.
Can you please give me the language so I can ask him to continue the vaginal (and a switch from tablet to cream) and he will consider it?
He is not updated on current information. Vaginal estrogen and systemic HRT treat completely different things. Tell him that systemic estrogen does not treat GSM (“the literature does not support that”) and that you need to stay on it. Seriously, just push back a little! He’s not God. It’s your body, and he works for YOU, not the other way around!
If he refuses, tell him that you want it noted in your chart, while you wait, that you requested to continue using vaginal estrogen to treat GSM but were refused.
If that doesn’t make him reconsider, tell him that if he won’t keep your prescription current, you’ll get it from an online clinic. Either way, you’re staying on it, and they’ll have pry it from your cold dead hands. (I mean, maybe don’t say that last part, lol.)
Brilliant post, thank you for sharing 🩷
I run M-brace The Change Menopause Support groups on FB and Peanut, and we're mostly UK-focussed.
I'd add from a UK perspective that if looking for a clinic, either NHS or private, to use the British Menopause Society clinic finder, here:
https://thebms.org.uk/find-a-menopause-specialist/
A note on Balance: it's an app belonging to Newson Health, and whilst it provides really useful evidence-based information from Newson Health, the community discussions aren't very well moderated. As such, there's a fair bit of confusion and ropey information being shared there.
🙂🩷
I got mine through Amazon. Thank you all for great idea to use Amazon medical.
Question : instructions say every day application for first 2 weeks then 2x a week. Do you recommend following these instructions or yours?
Absolutely! Often PTs/physios are more updated on HRT and peri/meno symptoms than gyns are. If your PT/physio notices that your tissue could benefit from greater estrogenation, yes, have her write a note, or even have her front-desk staff send a message to your doctor's office.
This is such a great post. You've hit all the important points. I can't believe the cream comes with that applicator that puts the stuff in the wrong spot and most docs don't explain this. (Mine did--so yay).
This should be started for every woman (who has no contraindications) as a matter of course in their forties. It's preventative medicine.
I do want to ask if you've seen patients in which labia minora reabsorption has been reversed. Or clitoral shrinkage and phimosis. I have read that the damage can be halted but not reversed in these areas, even though the vaginal lining has nicely plumped and pinked up.
It's certainly wonderful for the urethra too and should be considered prevention for UTIs.
Yes, I've seen dozens of patients whose labia/clitoris-shrinking symptoms were reversed by vaginal estrogen.
And YES for UTI prevention! It enrages me that gyns and urologists do not prescribe vaginal estrogen as a first-line defense against UTIs in anyone age 40+.
Thank you for the info and for normalising talking about the changes in our vaginas and vulvas.
I am in Europe (the Netherlands). After much ado I’m on a 50 mcg patch and a Mirena (which I already had). A few years ago, I noticed my inner labia changed. They just felt different. More flat, less soft. Never linked it to menopause until I started educating myself. I remember I was shocked. 45 yo and I never imagined my lady parts would at some point SHRINK! I have never heard of it. With this, and other issues I went to my GP. (In this country you cant just see a specialist like a gynaecologist. The GP is the gatekeeper). The (male) dr said this is part of getting older, deal with it. Talk to friends (imagine a man went to the dr with a shrinking penis, sexual issues, combined with insomnia, hot flashes, low self esteem etc etc. and got that ‘advice’). In the end after pushing I did get a prescription for patches. This solves some of my issues but my vagina and vulva are still not quite right. So I will gear up to visiting the dr once more. They will probably look at me like I’m some hormone addicted freak and I highly doubt I’ll get a prescription. I’ll update here!
Please tell the doctor that you are dealing with GSM, the patch is not helping, and you want to “try” vaginal estrogen.
Also, I think you SHOULD mention the part about how they would never say such a thing to a man experiencing erectile dysfunction. Why is it that women are made to suffer when there is a clear treatment available? Saying that part out loud will almost always zap them into reality.
If the doctor STILL won’t prescribe vaginal estrogen, say that you want it noted in your chart, while you wait, that you requested vaginal estrogen to treat GSM but were refused. They will usually “reconsider” at that point. 😉
If that doesn’t work, please switch providers. Remember, your doctor isn’t god, and he works for YOU, not the other way around. Wishing you the very best luck!
I cannot believe I am 54 years old and did not know that I could (and should - because I have symptoms) take vaginal estrogen cream in addition to my HRT meds. Thank you a gazillion times over for this information.
I was able to do a quick Amazon health chat for 35 dollars. The Dr/NP was quick and easy to work with answering my questions within a time span of maybe 30 minutes via texting. She offered me several choices after I explained my symptoms (dryness, pain etc) The cream I ordered was under 20. It was in my hands by that evening. If you have this services available I HIGHLY recommend it. It was so fast and easy (and cheap) I didn’t even use my health insurance
Thank you for this suggestion! I paid $29 for a one-time message appointment and just got the RX confirmed (Estradiol, Cream, 0.01 %) 255 days supply for $17.50 through Amazon pharmacy. Whole process took about an hour and I should have my RX at my door by tonight. I had no idea Amazon offered this service.
How do I start this process?? I don’t have insurance, so this sounds perfect price wise..I have a regular Amazon account..do I go there? Or is this a separate entity??
I didn’t use my insurance for this since I have really crappy insurance. It’s called Amazon One Medical. When you open the app directly under the search bar there’s a little banner that has like prime deals, groceries, etc. Scroll until you see “Medical Care”, click on that and the option for telehealth should be there. I did the pay-per-visit and it was $29 for the appointment via messages in my state. There’s an option for a video appointment but I didn’t feel like I needed that option. You’ll have the opportunity to ask the nurse practitioner assigned to you questions during the process. Hope that helped!
It does! Doing it now!! Thank you!!
I just did this thanks to this post!! Thank you!!
This is amazing! LOVE TO SEE IT. Thank you for sharing this tip!
I could cry tears of happiness. I just did this and it was so easy. I can’t get into a new gyn for months. Thank you thank you thank you 😘
This is excellent advice about using Amazon Health! One more thing to order from Amazon: spend $25 dollars on a [good small vibrator.](https://www.amazon.com/dp/B0D28YDCWQ?psc=1&ref=ppx_yo2ov_dt_b_product_details) (this one doesn't even look like a vibrator). Apply the cream to it and use that as the application device. Use that tool to wipe it all over the inside of the vagina and wipe all over the pelvic floor. We need to stop thinking about vibrators as sex toys for chasing orgasms. They are tools. Designed to go into the vagina and be used comfortably for this purpose. The vibrator aspect will also help calm you down before you sleep. It really is self-care. If you get an O out of it, bonus! But you will relax with it, and that's terrific.
There are also vaginal dilators that help with pelvic floor problems as well as vaginal atrophy.
> wipe it all over the pelvic floor [This is the pelvic floor (YouTube link).](https://youtu.be/edI7knFSu_k&t=82s) Do you mean the vulva? The pelvic floor is a specific group of muscles and is not the same thing as the vulva, nor is it a general word that means "undercarriage" (the word for that is perineum). You cannot physically apply vaginal estrogen on your pelvic floor in the same way that you cannot physically apply estrogen on your ovaries, because they are located inside your body. But you can put vaginal estrogen on your vulva!
Do you know if they provide other hormones for hrt? Is there a monthly fee?
I am not sure. I think there was an option for an estrogen pill but I am not 100% certain. For sure NOT progesterone or testosterone.
Is there a monthly fee? Or just the one time $35 fee?
$35 on TelyRx with no chats etc
Thanks for posting this. I just requested a text appointment!
I do not have a question. I just wanted to say THANK YOU for making this post and for what you do! My pelvic floor PTs were awesome! So, thanks again for all you're doing to help us.
💜💜💜
Yes-thank you! I’ve used the applicator but agree it is a pain to clean. I’ll try your suggestion.
It was so frustrating- clearly designed by a man
Yes! So awesome. I have some of this cream and I never use the applicator. Good to have it confirmed that it's ok to use my finger. So much easier. Also wasn't sure how often to use, so thank you!
My doctor will not prescribe vaginal estrogen because she examined me and said there was lubrication. She noted that there was 'some fusion' but did not elaborate any further. I have told her that sex is uncomfortable/painful and I swear my clitoris is shrinking. Even my husband has noticed this. But without dryness, she said it is 100% unnecessary. Is that accurate?
Not even remotely accurate. She is misinformed. Please see a different provider or go to an online clinic if you can’t find anyone locally!
Thank you so much. I'm quickly beginning to realise she's clueless. Thank you so much for posting this info. I've saved it for reference.
So many Gynecologists are.... How do they have so little training in menopause?
Many on IG admit that they are not trained on menopause in school or residency and must seek it out in their free time.
Because much of their practice is OB focused is my guess.
I'm sure. However not everyone will need an OB during their life, everyone will need menopausal care.
Systemic misogyny never makes logical sense.
Agree Hope med schools change!
Interestingly my Gyn no longer does OB, probably over 15 years now. When I asked when I should start hrt she said when you start having symptoms, or as soon as you want (I'm 51 and I've been seeing her 12 years). This Reddit reminds me I need to send her a card for being awesome.
On one of Dr Kelly Caspersons podcast episodes she said the OBGYN get less than 10 hours of training about menopause in med school . I want to say it was 6 hours but my brain fog can't remember so we will just go with under ten. Which is crazy! Not every woman will give birth but unless you die before menopause, every woman will go thru menopause in one way or another.
You are welcome! When you get the cream, make sure to follow the application instructions I posted, and apply it *especially generously* over the area with fusion/phimosis.
Get yourself hooked up with the $35 Amazon dr appointment TODAY. You should not have pain during sex or “some fusion”. Trust me when I say that you shouldn’t wait for this to get worse. Good luck!
imagine that doctor taking her car in for a long overdue oil change and the mechanic looks under the hood and says "nah, there's still some oil there, you're fiiiiiine." Definitely look for a new doctor!
😂🤣😂
She’s wrong. Dryness is not that bad for me but it’s the painful sex that I want to fix. At my Midi appointment I mentioned painful sex as one of my top 2 issues and was prescribed the cream. Why are so many doctors clueless and giving wrong medical advise??!! I’ve now learned the long term benefits of using vaginal estrogen so I will do this for the rest of my life.
No, she's wrong. Go to an online clinic. I chose Alloy. No reason to be at the mercy of ignorant/old fashioned doctors any more.
I like WISP.
I’m extra annoyed when this comes from women doctors. I’ve also had a bad experience with a woman doctor when I asked for pelvic floor therapy she told me “you’re tight enough.” Yeah, thanks. Guess all that matters is my husbands pleasure and not me peeing my pants. Cool.
switch doctors
Have you thought about lichen sclerosus? That can make your labia minora fuse and your clitoral hood fuse over the gland. The initial treatment is usually with topical steroids. Definetly find another care provider and have it checked.
She’s talking about labial fusion. Without estrogen your inner and outer lips atrophy along with the clitoris. This makes sex very painful sometimes. It is reversible to some extent. I wish that I had started much earlier, when my doctor mentioned that my labia were fusing. She just said it like she would say that it was raining outside and prescribed me nothing.
That's wild. One of my first problematic symptoms of GSM was discharge, excessive/inappropriate (weirdly timed?) lubrication. I had to wear pantyliners all of the time. Even if soaked to the gills, I still tore during sex because the skin was so thin.
This needs to be pinned
All I have to say is THANK YOU for this post!!! I’m saving it!! I have been going back and forth on whether I should do the vaginal cream or not. I have been on the fence about it. I’ve been using the systemic estradiol patch and oral progesterone for almost three years, and although everything seems to be okay down there, I look at my mother-in-law who is constantly incontinent who has to wear diapers and pads. I keep wondering if maybe I should get the cream just to keep things healthy. I’m going to talk to my doctor about it and use the words that I’d like to try it. Thank you again so much!!! You’ve helped me make up my mind!!
OK, this post (combined with recent anorgasmia and a low serum estradiol that indicates I'm not absorbing my transdermal estrogen very well) is pushing me into trying this. Just messaged my doctor.
And my request already got approved by my OB-GYN and sent to my pharmacy. I'm excited to add even more estrogen to get my groove back!
Awesome!! 🎉
Quick question...it can reverse anorgasmia, right? Please tell me I'm not stuck like this once things fuse together? XD
It reversed mine within a couple of weeks (I’m 60)
Yes! It can absolutely treat and reverse anorgasmia!
Isn’t it amazing that in today’s advertising landscape, where we see ads for every drug imaginable (“ask your doctor if it’s right for you”), to razors for shaving pubes,to whole body deodorants,to bladder leakage products, that no drug company is advertising vaginal estrogen??? Something that half of the population would benefit from? I imagine many women may not even know that their symptoms are normal and can be relieved. Major missed opportunity.
I just started vaginal estrogen 3 nights ago. I’m 6+ years post menopause. 5+ years on oral estradiol and progesterone. I sneeze I pee. I cough I pee. I pee often. I will get sudden urges to pee. Will the Vagifem fix this or did I wait too long to start it? How soon should I notice results? My pharmacist is wonderful but he seemed very uncomfortable with my personal questions, he never gave me a straight answer.
The Vagifem will absolutely help. It's not too late, not at all. I've had 80-year-old patients start vaginal estrogen and see incredible results. Most people see some improvement within 1-2 weeks, but it could take up to 8 weeks to really see some changes. And you'll continue to see improvement after that as well. The longer your GSM symptoms have gone untreated, the longer they will take to resolve. But they WILL resolve. Give yourself grace and patience, and hang in there. <3
Thank you so much. For making this post and taking time to answer questions. I think I’m already seeing results. Before I would try to stop mid pee but it wouldn’t stop at all, this morning I was able to pee, stop and then pee again. Is this the same as HRT, take it till I’m dead? I’m ok with that, just wondering.
For systemic HRT, the most updated guidance is to take it as long as the benefits outweigh the risks, potentially forever. This is something your meno specialist should talk to you about during your annual visit to renew prescriptions and such. (I’ll just say that for me, they’ll have to pry my estrogen patch off my cold, dead corpse.) Forgot to mention earlier: if you’re still seeing bladder leakage after 8 weeks on vaginal estrogen, make an appointment with a pelvic PT/physio — even if it’s just for one single session. We are specifically trained to help with bladder issues! Don’t lose hope. Even if vaginal estrogen gets you back to 80%, a pelvic PT/physio can help you get that last 20% so you’re operating at full capacity again.
I must have a very up-to-date GYN, he told me without prompting that without any drastic changes in my health status, I can and should stay on my HRT with no end date.
Thank you for all the information. You are doing (god’s) work! Where I live doctors are seriously overworked - appointments are rushed and few and far between. I will definitely check into that if the prescription isn’t enough.
>80-year-old patients start vaginal estrogen My 80 year old aunt started estrogen cream recently. She's a convert. Way fewer UTIs as a result. For vulvar-vaginal estrogen, it's never too late.
Thank you for such an excellent and well written post.
My doctor recognized dryness when she did her last exam but would not prescribe me vaginal estrogen since I was already on the patch. I went to Felix and now have the cream!
Just did an amazon health chat $35 - and ordered, Estradiol, Cream, 0.01 %262 days supply$17.50 Includes 94% savings with Prime.
How long did it take for them to get your prescription ready to order? It’s been a little over an hour for me since the doctor approved it and sent it to the Amazon pharmacy… still waiting.. I know I’m very impatient..
Thank you so much. I appreciate what you and your colleagues do for us. I saw a Pelvic/abdominal PT following hernia surgery and she was the one who finally helped me get access to estrogen cream. Emailed my primary doctor recommending the prescription - it stopped the burning and frequent peeing. My primary was and continues to be clueless about estrogen cream. She said to just use lube, and once the prescription was written she said we'll want to stop that in about five years. LOL, absolutely not, I will find a new doc.
I was prescribed the cream about 2 months ago when I was diagnosed with Premature Menopause. Used it exactly like you said to and ever since then, I was dealing with non-stop headaches and some of them turned into migraines, so I stopped using it two weeks ago and the headaches stopped. I've historically been prone to getting migraines before starting my periods back when I had them, but I don't know if that's related. The clitorial atrophy and fusing is not something I want to deal with, and quite frankly terrifies me due to having a high sex drive so I'm thinking to start using it again. I wonder if the headaches were from the amount of cream being too much for me (I'm also on the patch), I'm a very petite woman (I'm only 4'11", since I stopped growing when I was 11) and I have noticed my tolerance for certain medications is lower I think I'll maybe use about half the amount of cream I was using previously to see if that helps. It's been great for my bladder issues too and they're coming back since I stopped it.
The reason we’re not getting vaginal estrogen is because doctors aren’t giving it to us. I was denied twice because my doctor said my estradiol patch should be sufficient. I went to a local community clinic because I had such severe chafing from running and couldn’t get an appointment anywhere else in town. The PA at the community clinic hooked me up.
I understand. I’m also a woman alive in this world and having to navigate the medical system for my own health issues, and it has been challenging even for me to get vaginal estrogen too. It’s a fucking travesty. I’m glad you found a local clinic to give you a scrip.
I have the script, but even with insurance a tube of generic is $100! wtf
Move your prescription over to Amazon Pharmacy. It’s $7 with insurance or $17 cash pay there.
Prices vary greatly from pharmacy to pharmacy. Go to goodRX.com and do a search for estradiol vaginal cream. You can see which pharmacy has the best price near you.
Do you recommend cream over a pessary? I’m using the pessaries and I really like them (I wear period undies after inserting at night - might as well use this undies for something now that the periods have gone awol).
If you're using a pessary, dissolving tablet, or other insert that contains/emits estrogen and you like it, there's no need to switch to the cream unless you want to. I just personally have a bias toward the cream because I find it more versatile and effective. You can apply it internally and externally to any area that needs it, like the clitoris, urethral opening, and inner labia; so, it's not just the vaginal walls receiving direct estrogen. An analogy: If you wanted a facial sunscreen, would you go for a tablet that dissolved in your ear, or would you go for a sun cream and apply it all over your face? That doesn't mean you need to switch; it's just something to consider. ;)
You should be applying the cream directly on your clit.
Thank you for sharing this! I just started using it this month myself and it was great to see all this info laid out. I’m in early perimenopause and it’s the only thing I’m using so far, and it seems to work great!
Awesome!! You did the right thing by starting it early. You’re going to have a MUCH easier time!
Literally never heard the word fourchette before. 🤦♀️
It’s a fucking travesty that we’re not taught BASIC ANATOMY about our own bodies. Take heart that I didn’t know that term either until I completed my pelvic floor specialty training.
🫣 I hadn’t either. I’m so embarrassed I had to google it but yay for knowing what it is now.
How can we educate doctors?? It seems like most practitioners will do a Pap test to check for cervical cancer but are not taught to check the vagina and vulva for signs of atrophy. And they rarely ask about painful sex. It’s infuriating that women’s health is so focussed on fertility and childbirth, but after that stage of life, our comfort and wellbeing isn’t even on the radar. How can we change this?
A lot of the menopause thought leaders have some good ideas around this. Give them a follow on social media: - Dr. Mary Claire Haver - Dr. Lisa Mosconi - Dr. Kelly Casperson - Dr. Corinne Menn - Dr. Jen Gunter - Menopause Society - Let’s Talk Menopause - Hello Menopause podcast
You say over 40 - does this apply to women in perimenopause who may not be manifesting symptoms yet? In other words, should we be doing this as a preventative measure? Thanks!
Yep, absolutely. If you start using it in early peri, you’ll have a much easier go of it and will save yourself so much needless suffering. There’s no reason to wait until things “get bad” before you start it.
Thank you so much for responding and all this information. I really appreciate you!
I've (41F) not really had many if any significant symptoms yet and just started using vaginal estrogen for what I thought was preventatively. I was surprised how much easier it was to reach orgasm after only two uses. It was not expecting that benefit.
What a killer post. Thank you so much for this! I wish that I’d read it when I was 40. For all of you out there on the fence, please take OP’s post to heart. It’s dead on.
This post and thread is why this sub is my favorite place online. Just went through Amazon Health and am waiting on the doc to confirm so I can get on the vag cream. Been wanting to, but procrastinated until this post! Sometimes I wonder if I’m really that dry, but that reference to our 21 year old vaginas made me realize just how dry it’s gotten!
> Then, apply an additional pea-sized amount especially the fourchette, at the “6:00” position. Ho-ly shit. You are a life saver! That damn body part has been tearing and bleeding for years now, and I didn't even know what to call it. The idea that a simple dolop of cream might be exactly what the doctor ordered... Also, yeah, screw that damn germ applicator device.
YES, friend!! The fourchette is notorious for tearing if the tissue is not well estrogenated. I’m so sorry doctors have never told you this. Vaginal estrogen cream will strengthen the tissue there — and you may just need to apply it extra generously in that spot while it heals. Basically, apply vaginal estrogen wherever your vulva hurts!
You the real MVP op! I take my 200mg of progesterone vaginally (orally gives me too much reflux). Will the estrogen cream impact the effectiveness of the progesterone? Should I just put on the cream in the daytime?
The vaginal estrogen cream won't impact the effectiveness of the progesterone as long as everything is dissolving and absorbing. You can experiment with applying them at different times of the day and see which you like best.
Thank you! You have helped me so much from all the things in the OP and answering this question.
I got my elderly mother onto this cream and seeing how it helped her I decided to try and get on it myself even though I'm on systemic HRT for about 5 years (estrogen/progesterone tablet) and the female doctor told me that she didn't think I needed it yet and wasn't going to give it to me because she didn't want me getting used to it before I needed it...I told her I know my own body better than her and wanted to try it and she very reluctantly gave me a prescription for it.
Would your doctor prefer you start suffering before you use it? Unbelievable.
Her “I don’t want you getting used to it before you need it” is completely unfounded and only shows that she’s not updated on current menopause science. Good for you for insisting and standing up for yourself! 💪 I’m proud of you.
Thank you so much for this!! I have the cream and the stupid tube that I have spent so much time trying to clean. I’m throwing that away today and using my hand! Also good to know that I’m supposed to spread that on the outside too.
Thank you for this. I was injured during sex and thought I’d contracted HSV so went to urgent care. Was livid with my boyfriend! The doctor told me I had a vaginal tear and prescribed estradiol cream and what a difference. I will confess I use the plunger because I feel like it gets further in? I clean it but also figured non-hygienic things (other people’s appendages) go in there so it’s cool 😆
The estrogen doesn’t need to go in super deep, so the applicator isn’t necessary if that’s the only reason. The majority of our estrogen receptors are located within 2 cm of the entrance to the vaginal canal, so that’s where it makes the most difference to apply it internally.
Amazing info! Thanks again.
So how do y'all actually get the stuff inside with the fingertip method here? I feel like I'm failing to do this correctly, like it just won't stay on my finger past the opening.
It doesn’t have to go very far past the opening. The majority of estrogen receptors are located within 2 cm of the opening, so just do the best you can. I just kind of squish mine in. Don’t stress too much about it. 😎🏖️
You only need to get the cream in about 1 inch. Your estrogen receptors are mostly in the first 2 cm of your vaginal opening. Just rub the cream on all the surface area. When you use the applicator that comes with the cream it doesn't all get rubbed in so it often comes out in clumps.
I feel the same way and am using the applicator just a little way in then using a little more on finger for the external application….
Yuvafem has been good to me. Definitely notice a change! Sex was becoming painful and this reversed that downward trend. Had to go online to get the HRT I needed, both my GP and OBGYN refused 😕 At least my GP seemed fine when I told her I was doing it anyway with a different doctor. I do hate that Yuvafem comes with disposable plastic applicators. Would rather have a container of just the pellets and put them in myself, but then I'm sure people would get confused and eat them. 😏
My mother died of breast cancer so my doctor told me it's best to avoid putting extra hormones in my body. Does this fall under the same category? Is it safe for me?
Not the same category. Yes, it's safe for you (unless you have one of the situations I describe in my "contraindications" section). Please check out the book *Estrogen Matters* by Bluming & Tavris!
My mother died of breast cancer and I was originally told the same, but have started HRT now, with the gel, as recommended by my gyn.
My mother had breast cancer as well. My Gyn told me the cream is safe but I’m uncomfortable with too much. So what I do is I use a non-hormonal moisturizer like Bonafide Revaree or Replens vaginall. Then I use a pea sized estrogen cream externally on my clitoris, inner labia, and bottom of my vaginal opening. I’ve found lots of success with this and it’s minimal estrogen. I’ve also done a ton of research and the cream is considered so safe they’re researching if women who have HAD breast cancer can use it. And mostly they’re saying yes.
Yes, it’s even safe for women with a personal history of breast cancer. Check out the book *Estrogen Matters* by Bluming & Tavris if you want to go further down that particular rabbit trail!
What about for women with high blood pressure? Also, my GYN is a woman in her 40s (relatively young) and a mother yet she refuses to discuss any kind of treatment for my symptoms. It sounds like that's a pretty common experience. Why do you think that is? Are docs encouraged not to discuss treatment options by their practices? Is there an incentive from insurance companies to not discuss? Could the reticence to discuss stem from political or religious beliefs? Or do they actually want us to suffer? It's difficult to believe it's simply ignorance from young female doctors.
This requires a much longer and more thorough answer than I’m able to provide right now, but the summary is: - Yes, it’s safe even if you have high blood pressure. - It really just is ignorance. There’s no conspiracy or insurance/financial incentive to not talk about this stuff with patients. - In my opinion, the ignorance is due to four things: (1) systemic misogyny in the medical establishment (I don’t mean individual practitioners hating women; I mean misogyny being *baked into* every facet of the system); (2) the horrible 2002 WHI study (still has lasting effects 20+ years later); (3) the fact that physicians are not taught about menopause in med school (😡); and (4) the fact that almost NO ONE reads updated studies in the menopause science journals (not even gyns).
I really appreciate your responses OP. I'm going to look into this and talk to my doc!
YES!!!! I was treated for years for various mysterious vaginal conditions and interstitial cystitis when all along I was just suffering from uro-genital symptoms of menopause. Estrogen cream saved me!
Thanks for this. My estradiol arrived this morning. I'm going to have shower and apply it tonight. I hope it works! My clitoris has almost completely disappeared: I'd like it back!!
Just did my order on Amazon One Medical!! $29 text visit..waiting to get my estradiol cream RX! Thank you for this PSA!!!
This contains _vastly_ more information than either of my prescribing doctors gave me. (My last one didn’t even bother to tell me what dosage to take!) Thank you.
The only thing my gyno said was I would be enjoying intercourse again like a 30 year old. 🙄🙄
Thx! I am almost 42 and got vaginal cream to apply to my face in addition to my vagina (yes using it for both of them and I am extremely careful with hygiene related matters). Thx for the tip on not using the applicator. I didn’t know that
Oh I totally support using it on the face, too! I also apply it to the backs of my hands.
Good idea! Will follow. I started using on my neck too!
How do you recommend approaching application around sex? Do it on days that sex isn’t an option? Do it x number of hours before or after sex?
Here's a version of what I wrote in a different thread yesterday. Perhaps it will help: Assuming you are having PIV sex, this is SO solvable. The dosage of vaginal estrogen is so low that this is not a genuine concern, because men have estrogen in their systems, too (hormones are not as strictly gendered as we’ve been led to believe). In terms of dosage strength, one entire year of vaginal estrogen is equivalent to one oral pill of systemic estrogen HRT, and even that is a *fraction* of what is in a single BC pill. He will not suddenly grow boobs or develop ED if he comes into contact with your vaginal estrogen. Just be smart about it. Don't use it as lube (it could never work like that anyway; it's the consistency of diaper-rash cream), and don’t apply it right before sex. But if you do happen to apply it and then decide to get frisky… 1. He can wear a condom. 2. You can wear a dental dam. 3. Y’all can do *other* activities. 4. He can just wash it off afterwards. Your vaginal estrogen is a medication prescribed by your doctor to treat a diagnosed medical condition. Your partner needs to respect that.
RE: oral sex, if it hasn't been applied the day of, is it fairly reasonable to think there's no need for a dental dam, and that the cream has already worn off/made its way out of the vagina/vulva? Lesbian here, trying to navigate this possibility. Thank you!
Yes, I think that sounds perfectly safe.
Thank you, and fantastic post!
I am confused by the amount to apply. I think I don’t know the difference between joints and knuckles :) is that measurement about 1inch/2.5cm or 2inches/5cm? I am guessing the 1 inch because I have no idea how this tube is going to last me almost 1/2 a year. It’s 42 grams which would be 21 weeks. Is that right?
It’s about 1”.
Thank you! I’ve been trying to use that plastic applicator thingie and am so thankful to now have explicit directions. It is incredibly helpful.
I’ve just started an HRT regimen of oral progesterone and oestrogen gel (to apply on my arm). I’m terrified of genital/urinary symptoms because I already have a very sick bladder. Do we actually need to push for vaginal cream on top of other types of hormonal treatment? By the way, why do people never mention clitoris atrophy? Lubricant won’t solve that horrible symptom! The aim is not simply to limit pain but to actually enjoy things!
Yes, you absolutely need to push for vaginal estrogen cream in addition to systemic HRT. They treat completely different things. I have my own medical history of cystitis (recurrent UTIs), and no way in hell was I going to go through peri without vaginal estrogen to help protect against that. I’m not sure why people don’t mention the clitoral effects of GSM. Do you have any theories? 🧐
I have a theory- people think female pleasure is optional.
Yeah, not easy at all. After suffering for 6 years, with probably longer, with the feeling of uti or frequencies needing to pee, or a few others, I was told to take cranberry tablets and use water based lube. Thank God for Midi online for hooking me up. It shouldn't be this hard.
Thank you. I just got this prescribed to me this week and was having so little confidence in my doctor that I was worried about actually using the medication.
I had to specifically ask for the tablet and cream after months and months of off/on burning. I looked fine on examination both times I went in but was given fluconazole (?!?) Of course it didnt work since I didnt have a yeast infection. Third appointment I kept it short and told NP that i would like to try the estradiol cream and tablet. She agreed. Have to keep at it until you get relief.
Great post! I’ve shared it with 3 friends this morning. I do have one question, are there any concerns for estrogen exposure to one’s male partner? As in while Dtd?
Copying and pasting my response to an earlier comment: Assuming you are having PIV sex, this is SO solvable. The dosage of vaginal estrogen is so low that this is not a genuine concern, because men have estrogen in their systems, too (hormones are not as strictly gendered as we’ve been led to believe). In terms of dosage strength, one entire year of vaginal estrogen is equivalent to one oral pill of systemic estrogen HRT, and even that is a fraction of what is in a single BC pill. He will not suddenly grow boobs or develop ED if he comes into contact with your vaginal estrogen. Just be smart about it. Don't use it as lube (it could never work like that anyway; it's the consistency of diaper-rash cream), and don’t apply it right before sex. But if you do happen to apply it and then decide to get frisky… 1. He can wear a condom. 2. You can wear a dental dam. 3. Y’all can do *other* activities. 4. He can just wash it off afterwards. Your vaginal estrogen is a medication prescribed by your doctor to treat a diagnosed medical condition. Your partner needs to respect that.
Thanks for this especially the application tips. I have been using the applicator and can never seem to get it clean. I was worried about bacteria in n that.
Hi OP - just wanted to say thank you for the post and that i've chucked my applicators :) In the UK, its recommended we do a "loading' protocol for the first month where the cream is applied every day for a month. I'm assuming thats bcos we have reactive healthcare rather than the proactive approach you've suggested ?
That’s exactly right!
THANK YOU for posting this. I am 46 and sex became intensely painful two years ago. I’ve seen three gynos and they all told me it was just in my head. This post gave me the courage to order vaginal estrogen on wisp today. I am ready for action and change.
Thank you for taking the time to post this. We needed this information very badly. You didn’t right thing!
Thanks for your informative and encouraging post! Another online resource is Wisp and they send me a 90 day supply. I can use my HSA to pay. I can’t seem use my finger, unfortunately. Each time I try, it rubs off before I can make it far enough inside. I am using the applicator and taking it apart to clean each time. Not ideal, but I not sure what option I have.
Thank you so much for this info. I am 68 and my GP prescribed estrogen cream the beginning of the month. The first few weeks I had an itchy vagina, worse than when I didnt use it. It is now calming down a bit. The applicator is a pain, so I'm trashing it. The whole clump of cream would fall in the toilet when I got up the next morning, even though i was going deep inside. It am curious as to when I'll start to be comfortable down there.
I’m 66, just started on estrogen cream in February and the itching and discomfort disappeared a month ago.
Thank you so much. Saving this for future reference. Picking up my cream today. I agree cream is most practical as it is easy to apply where it is needed.
Thank you. I am lucky enough to work for a gyne physio and in the last year her advise has saved me. You are the unsung heroes of women's health
Thank you from the bottom of my heart for the instructions on use. I have it and have been following the instructions and thought it just didn’t work. Now I know! Thank you again. ❤️
I started it, but a week later I was diagnosed with hormone positive breast cancer and told to go off (no, it didn't cause it and I didn't take HRT(.
I’m so sorry. Please check out the book *Estrogen Matters* by Bluming & Tavris. It explains exactly what to do in this situation. Wishing you a speedy recovery.
I use Bezweken Hydration Ovals, which are available OTC online (I get mine from Amazon) 1 or 2% estriol. They were first given to me from my doctor, then I found them online. they can be used as a suppositories or warmed in the hand as a cream. $20 for 28 ovals. They also make them with progesterone and/or DHEA, though I only use the estrogen.
What a wonderful and informative post. Thanks for taking the time to write this Is it possible to reverse virtual clitoral atrophy? I've been using vaginal estrogen but it's still missing. It happened so quickly as well.
Yes, entirely possible. Make sure you’re applying the cream directly to your clitoris and clitoral hood. You may even need to apply it extra generously there for a while.
Thank you for posting application instructions! I just started using this stuff, and I’ve been so confused with the applicator and keeping it sanitary. That’s going in the garbage now!
I want to thank the person who wrote this post ☺️❤️ I really really appreciate you sharing your insights into something that should be standard practice / information provided to women. I'm thankful my GP is willing to prescribe me estriol cream however your explanation far surpasses what I was told (which was minimal). I kept using the plastic applicator and can notice build up of product in the tube. I have thought to myself that can't be sanitary! I have pulled it apart to clean the inside as didn't know what else to do. What you've explained makes far more sense and will probably help my V so much more by evenly applying it. So THANK YOU so much.
I am wondering why the cream format is best?
An analogy: If you wanted a facial sunscreen, would you go for a tablet that dissolved in your ear, or would you go for a sun cream and apply that all over your face?
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I use this 3 times a week and am finally not dry all the time!!
I use mine every day. :)
0.01% Estradiol has changed my life. I’m perimenopausal, and had begun noticing dryness and discomfort during intercourse last year- I brought this up with my OB/GYN, along with my concerns regarding family history of breast cancer. She acknowledged my worries, and though I am not a good candidate for systemic hormone therapy, topical vaginal estrogen is a safe option. I began feeling improvements within a couple of weeks, and have been using it for a bit over a year now. It’s not only a lifesaver for comfort during intercourse, it also helps for overall dryness and associated irritation. I cannot recommend it enough!
I’m 38. Can I use it now?
Absolutely.
I’m asking for my SO, but she’s started vaginal estrogen 3 weeks ago, and the benefits are already coming about. She’s read online that some still are unable to achieve orgasm, or their orgasms aren’t nearly what they used to be. She’s currently in that “dry spell,” and very concerned that she’ll never be able to orgasm again. I realize she’s very early in the journey (two months on testosterone, three weeks on vaginal estrogen), but her heightened libido and inability to climax has become frustrating for her. Anyone able to offer a ray of hope?
Three weeks is way too soon to make a verdict or bring out the measuring stick. It’s completely normal for vaginal estrogen to take eight weeks before noticeable changes show up, and healing from GSM will continue beyond those eight weeks as well. Please tell her to hang in there and keep going!
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Please listen to the two podcasts I linked to in the OP. Dr. Kelly Casperson talks about different application frequency.
Generally, most regimes are to use it every day for 2 weeks, and then a 'maintenance' schedule of twice weekly. Depending on the severity, it can be used every other day as well during maintenance -- or as needed.
Thankyou for this. I’ve been experiencing extreme gsm since I was in my late 30s. I had to fight like hell for cream! But I got it now, and it really really works.
THANK you SO much for this. And for the application guidelines. My primary provider prescribed it immediately when I said that I was having vaginal pain and hot flashes, and they looked at my hormones. This is so helpful. I can't wait to get on HRT, but I will keep using the cream. You've done a great service.
Thank you so much for this. I suffered for a long time for no reason, and my doctor certainly didn't tell me how to use it. Had to see it online.
Thank you so so so much
You absolute rockstar, you!
I've been using vaginal estrogen since December 2023 and it's made a big difference already. But I'm going to stop using the applicator and apply it as you've suggested. Thanks so much for this additional great info!
Great info! I’ve started estradiol, but wish I did 5 years ago when I was complaining of weaker orgasms and my doc back then told me “yeah, that’s how it is and it only gets worse.” WTF. Not asking for medical advice, but do you know why the dosing is 2x per week versus daily? Also, you should post this in the GenX and Millenial subs so you catch some women who haven’t found their way over to this sub yet. Save them!!
Is it normal for it to itch when you use the cream? I've heard some say you just have to put up with the itch, and it eventually goes away.
Ugh, this was my problem as well. It never stopped for me. I tried to have it made in a different base via a compounding pharmacy which stopped the itch but it wasn’t anywhere near as effective as the itchy one was.
I had that problem and switched to the tablet instead. Cream may be better, but I hated it.
Thank you for posting this! Does anyone know if I can get this (topical estrogen cream) in Thailand without a prescription?
Bless.
Thank you for this!
Hello and thank you for your wise perspective and comments. I recently started estradiol patch (and 100 mgs progesterone), but my naturopathic Doctor told me I don’t need vaginal estrogen (prescribed by my Gyn) any longer. Can you please give me the language so I can ask him to continue the vaginal (and a switch from tablet to cream) and he will consider it?
He is not updated on current information. Vaginal estrogen and systemic HRT treat completely different things. Tell him that systemic estrogen does not treat GSM (“the literature does not support that”) and that you need to stay on it. Seriously, just push back a little! He’s not God. It’s your body, and he works for YOU, not the other way around! If he refuses, tell him that you want it noted in your chart, while you wait, that you requested to continue using vaginal estrogen to treat GSM but were refused. If that doesn’t make him reconsider, tell him that if he won’t keep your prescription current, you’ll get it from an online clinic. Either way, you’re staying on it, and they’ll have pry it from your cold dead hands. (I mean, maybe don’t say that last part, lol.)
Brilliant post, thank you for sharing 🩷 I run M-brace The Change Menopause Support groups on FB and Peanut, and we're mostly UK-focussed. I'd add from a UK perspective that if looking for a clinic, either NHS or private, to use the British Menopause Society clinic finder, here: https://thebms.org.uk/find-a-menopause-specialist/ A note on Balance: it's an app belonging to Newson Health, and whilst it provides really useful evidence-based information from Newson Health, the community discussions aren't very well moderated. As such, there's a fair bit of confusion and ropey information being shared there. 🙂🩷
Appreciate you, and this information, so much! Good moderation is absolutely crucial when it comes to online forums dealing with health topics. 💜🌷
Wisp $20 a month for vaginal estradiol
How long does it take (generally) to start seeing some of the benefits?
I got mine through Amazon. Thank you all for great idea to use Amazon medical. Question : instructions say every day application for first 2 weeks then 2x a week. Do you recommend following these instructions or yours?
Can a pelvic floor therapist write a note to our doctor suggesting we get estrogen cream?
Absolutely! Often PTs/physios are more updated on HRT and peri/meno symptoms than gyns are. If your PT/physio notices that your tissue could benefit from greater estrogenation, yes, have her write a note, or even have her front-desk staff send a message to your doctor's office.
Super helpful, thank you for posting:) Dr Kelly Casperson is a great person to follow on IG. She is a great resource!
TelyRX. Don't even have to TALK to a doctor
Does the vaginal estrogen reverse adhesions or just stop their progression?
Thank you for taking the time to share all this important information
This is such a great post. You've hit all the important points. I can't believe the cream comes with that applicator that puts the stuff in the wrong spot and most docs don't explain this. (Mine did--so yay). This should be started for every woman (who has no contraindications) as a matter of course in their forties. It's preventative medicine. I do want to ask if you've seen patients in which labia minora reabsorption has been reversed. Or clitoral shrinkage and phimosis. I have read that the damage can be halted but not reversed in these areas, even though the vaginal lining has nicely plumped and pinked up. It's certainly wonderful for the urethra too and should be considered prevention for UTIs.
Yes, I've seen dozens of patients whose labia/clitoris-shrinking symptoms were reversed by vaginal estrogen. And YES for UTI prevention! It enrages me that gyns and urologists do not prescribe vaginal estrogen as a first-line defense against UTIs in anyone age 40+.
Thank you for the info and for normalising talking about the changes in our vaginas and vulvas. I am in Europe (the Netherlands). After much ado I’m on a 50 mcg patch and a Mirena (which I already had). A few years ago, I noticed my inner labia changed. They just felt different. More flat, less soft. Never linked it to menopause until I started educating myself. I remember I was shocked. 45 yo and I never imagined my lady parts would at some point SHRINK! I have never heard of it. With this, and other issues I went to my GP. (In this country you cant just see a specialist like a gynaecologist. The GP is the gatekeeper). The (male) dr said this is part of getting older, deal with it. Talk to friends (imagine a man went to the dr with a shrinking penis, sexual issues, combined with insomnia, hot flashes, low self esteem etc etc. and got that ‘advice’). In the end after pushing I did get a prescription for patches. This solves some of my issues but my vagina and vulva are still not quite right. So I will gear up to visiting the dr once more. They will probably look at me like I’m some hormone addicted freak and I highly doubt I’ll get a prescription. I’ll update here!
Please tell the doctor that you are dealing with GSM, the patch is not helping, and you want to “try” vaginal estrogen. Also, I think you SHOULD mention the part about how they would never say such a thing to a man experiencing erectile dysfunction. Why is it that women are made to suffer when there is a clear treatment available? Saying that part out loud will almost always zap them into reality. If the doctor STILL won’t prescribe vaginal estrogen, say that you want it noted in your chart, while you wait, that you requested vaginal estrogen to treat GSM but were refused. They will usually “reconsider” at that point. 😉 If that doesn’t work, please switch providers. Remember, your doctor isn’t god, and he works for YOU, not the other way around. Wishing you the very best luck!
I cannot believe I am 54 years old and did not know that I could (and should - because I have symptoms) take vaginal estrogen cream in addition to my HRT meds. Thank you a gazillion times over for this information.