You want me to put that cream WHERE?

Author: Dr. Blair Green PT, DPT, OCS, PHC

If you are over the age of 40, you’ve likely heard about hot flashes, brain fog and MHT (aka HRT). These topics seem to be a mainstay of my friends and family, especially now that perimenopause is having a moment. Trust me, I’m grateful that women are talking about it, that doctors like Dr. Rachel Rubin and Dr. Kelly Casperson are leading from the front lines with the FDA and that we are finally starting to tip the scales on not only making necessary therapies available to women all over the country but also educating people on the very real physical and mental changes that accompany the loss of estrogen in midlife.  Before you tell yourself, “Yes, I have my patch,” and click to another blog, I have one more question:

Have you filled your prescription for vaginal estrogen?

That’s right - vaginal estrogen. If you have, great! I’d still love for you to keep reading, or at least share with a friend. If you haven’t, let this article be my recommendation that you call your GYN or PCP and request this as soon as possible. I know, it’s one more prescription to fill, one more thing to remember and yes, it involves sticking a cream or tablet inside your vagina. However, this one can literally save your life. 

No, I’m not exaggerating. Vaginal estrogen has been shown to prevent urinary tract infections in older women. It helps maintain the pH of the tissue in the vagina, which, in turn, prevents bacteria from growing. I know, you’re thinking a little UTI never hurt anybody. Except it has. In older women, a UTI can quickly grow from a controlled local infection to full-blown sepsis. Once that infection hits your blood stream, it’s a medical emergency. Many women die from this exact situation every year. For this reason alone, every woman in midlife and beyond should be using some version of vaginal estrogen.

If that is not enough to convince you, it also can help improve other symptoms of the Genitourinary Syndrome of Menopause (GSM). I realize that’s a mouthful but it’s an important thing to know about. GSM is the term to describe all the dryness, thin tissue, urinary urgency, pain with sex, and any other age-related changes and symptoms that occur in the vulvovaginal area. In other words, vaginal estrogen, besides preventing UTIs (and possible sepsis), also helps ease pain, dryness and frequent urination. So why wouldn’t you use it?

I know, you’re probably thinking you don’t need it. You are using your patch or cream regularly. Systemic estrogen therapy, as part of MHT, does not affect the vaginal area. They are two completely different medications. If you are worried about side effects, they are minimal; vaginal estrogen is not absorbed into the bloodstream. It’s not expensive and easy to apply as a cream. It can also be prescribed as a ring, tablet or suppository. Each option has its own pros and cons and you should discuss with your doctor which is best for you. Additionally, large studies with large sample sizes have found it to be safe in women who have experienced breast cancer. 

If this is something you would like to try (and from this blog I’m hoping you are super-enthusiastic about it), have a discussion with your doctor about what type of vaginal estrogen may be best for you. 

Have further questions? Want to know more? Comment below and I will respond. Remember, as a physical therapist I cannot prescribe medication. I simply report the data and make recommendations so that you may have a conversation with your doctor.

Reference: American Urological Association, 2025.