Estrogen, a hormone that is produced in lower quantities beginning in the years before menopause, is available in synthetic form as tablets, rings, and creams. There are two types of vaginal estrogen creams--conjugated equine estrogen (CEE) cream (Premarin cream) and estradiol cream. For the CEE cream, 0.5 to 2 grams is inserted vaginally once a day. After two weeks, patients are usually instructed to use the cream three times per week. For the estradiol cream, the dosage is 2 to 4 grams per day for the first one to two weeks, and then 1 grams three times per week.

In 2002, the Women's Health Initiative (WHI) study was abruptly halted because it was found that estrogen/progestin tablets were actually increasing the risk of heart attack, stroke, dementia and breast cancer for women enrolled in the study. Since that time, experts have recommended that physicians prescribe the lowest possible dose of estrogen for the shortest possible amount of time. Vaginal estrogen creams, if used correctly, can fill this need. They are also more effective for women who have vaginal menopausal symptoms like dryness, burning or itching but don't have hot flashes and other problems associated with menopause.

Even though vaginal estrogen creams are being placed on the outside of the body, they do absorb into the bloodstream and enter all parts of the body. That's why it's so important to apply them correctly--using just the right dose. If you use too much of the product, your blood levels will become too high and you will get side effects. The mild ones are breast tenderness, vaginal bleeding and headaches. The serious side effects are uterine cancer and heart disease.

When women who have not had a hysterectomy take supplemental estrogen, they also take a progestin to lower their risk for endometrial cancer. At the moment, it appears that women who use vaginal estrogen cream for a short period of time do not need supplemental progestin. If you are using the product for a long period of time your physician may decide that you need supplemental progestin.

There are many vaginal estrogen creams that you can purchase without a prescription. These products are not approved by the Food and Drug Administration for the treatment of the vaginal symptoms of menopause. Most of these products are made from the phytoestrogens found in soy and yams. At the present time, experts do not recommend the use of these products. However, the do recommend that everyone, and particularly menopausal women, eat a plant-rich diet, because these phytoestrogens have been shown to prevent cancer.