Topical estrogen can help with painful sex and prevent recurring UTIs in perimenopausal and menopausal women. So why aren't more women using it?

Despite the significant impact it has on women, menopause — the biological process that marks the end of a woman’s menstrual cycle — is still highly misunderstood and undertreated.

The same goes for perimenopause, or the transitional period leading up to menopause when women’s estrogen levels begin declining. For some women, perimenopause can start as early as in their 30s, though it’s typically seen in women ages 40 to 44. As for menopause itself, it can begin in women’s 40s or 50s, with the average age being 51 in the U.S.

Both perimenopause and menopause can last for several years each. The average duration of perimenopause is four years, while menopause usually lasts about seven years. But in some cases menopause can last for up to 14 years, depending on different factors such as smoking, the age it began and ethnicity. Menopause is not officially diagnosed until a woman has gone without a period for 12 months.

However, about 30% of women never seek out information about menopause before experiencing it themselves, according to the 2021 State of Menopause Study, which included 1,039 U.S. women ages 40 to 64. Additionally, 45% of women don’t know the difference between perimenopause and menopause. This underscores the need for more education and awareness — especially considering how perimenopause and menopause can affect women's quality of life.

Case in point: An estimated 85% of women going through menopause will experience a range of symptoms, including hot flashes, night sweats, vaginal itching, burning and dryness (aka vaginal atrophy), chronic urinary tract infections, mood changes and painful sex.

However, there’s an effective treatment for several of these symptoms that’s not getting as much attention as it should, according to experts: vaginal estrogen. Here’s what you need to know.

‘Vaginal estrogen is the holy grail’

Experts are finally starting to talk more about perimenopause and menopause, as well as effective treatments for these symptoms — specifically, Dr. Ashley Winter, a urologist in Los Angeles, who has offered her insight via X (formerly known as Twitter) about topical estrogen and how it can help treat a variety of menopause-related symptoms. Now more experts are weighing in with similar sentiments.

“Vaginal estrogen is the holy grail for managing postmenopausal vulva or vaginal symptoms and recurrent UTIs,” says Dr. Fenwa Milhouse, a urologist in Chicago. “It is recommended by the American Urological Association for postmenopausal women with three or more UTIs per year due to its proven benefit in reducing the incidence of UTIs.”

And its benefits don’t stop there. “So many postmenopausal women suffer from burning, painful, itching or irritating vulvovaginal symptoms and/or painful sex, and vaginal estrogen helps with this too,” says Milhouse. “Every single postmenopausal woman with UTIs, painful sex or vulva or vaginal symptoms should be recommended to use vaginal estrogen.”

Dr. Anika Ackerman, a urologist in Morristown, N.J., agrees. “I believe that peri- and postmenopausal women need vaginal estrogen,” she says. “From a urologic perspective, which is my specialty, lack of estrogen leads to UTIs, urinary urgency, frequency, incontinence, dryness and painful intercourse, and [while] I believe hormone replacement therapy is safe, vaginal estrogen is even safer [as] it is not absorbed much systemically and has an incredible effect locally on the vaginal tissues.”

Vaginal estrogen helps thicken the mucus membranes of the vagina and lowers the pH of the vagina to prevent infections, as well as increase lubrication to improve itching, dryness and discomfort, says Ackerman.

Vaginal estrogen is ‘extremely safe’

Despite the fact that most experts agree topical estrogen is safe, there’s still a widespread misconception that vaginal estrogen can lead to health problems, such as an increased risk of cancer and blood clots. “There should be no concern about using vaginal estrogen,” Ackerman says. “It does not increase cancer or clotting risk [and] is necessary for most aging women.”

Dr. Rena Malik, a urologist and pelvic surgeon in Newport Beach, Calif., who specializes in sexual health, agrees, tells Yahoo Life: “Vaginal estrogen has so many benefits and the best part is it’s extremely safe.”

Malik adds: “There has never been a reported uterine, breast or ovarian cancer related to vaginal estrogen use, though sadly there is a lot of misinformation and misinterpretation of the data when it comes to women's hormone management, and when a doctor is not comfortable explaining the treatment, they often don't prescribe it.”

When it is prescribed, vaginal estrogen is offered in three different prescription formulations: a cream, a suppository and a ring. “The cream and suppository is dosed once daily for two weeks and then two to three times a week after that forever,” says Malik. “The ring is inserted intravaginally and replaced once every three months.”

Milhouse highly recommends vaginal estrogen for her patients — including those with a history of breast cancer. “I’ve seen countless of my own patients' lives changed after instituting vaginal estrogen,” she says. “Unfortunately, it is underutilized by both prescribers and patients thanks to the demonization of estrogen hormone therapy. Estrogen risks have been overemphasized and its benefits minimized or ignored.”

Dr. Kevin Chu, a urologist in Los Angeles, echoes his peers’ statements. “There is some stigma and concerns around hormone replacement therapies, but studies have shown the medication is very safe, and the benefits are significant,” he tells Yahoo Life. “It can stop recurrent UTIs, improve vaginal health and decrease pain with sex.”

If you’re experiencing symptoms associated with perimenopause, menopause or postmenopause such as vaginal dryness, painful sex and recurring UTIs, experts recommend asking your doctor about vaginal estrogen, which can help.