The fact that we can now say ‘vulva’ or ‘vagina’ in the opening line of a mainstream article – and not just a medical journal – says a lot about how far we’ve come. For centuries the parts of the body most central to women’s health were also the least talked about. That silence hasn’t just been cultural, it’s been harmful.
Now, intimate health is stepping out of the shadows. What was once relegated to the category of ‘unmentionables’ (it’s not that long ago that we used words like ‘inexpressibles’ to avoid saying ‘trousers’) is not only being openly discussed, but trending. And the latest topic under the spotlight (no stirrups involved)? Vaginal oestrogen.
Social media – particularly TikTok – has sparked a wave of candid conversations, including the viral (and slightly surreal) focus on labial changes during menopause. While it might sound like oversharing, it’s rooted in something real; the hormonal shifts that affect almost every woman.
Experts estimate that the majority of women will experience Genitourinary Syndrome of Menopause (GSM) to some degree. As oestrogen levels decline, tissues in the vagina, vulva, bladder and urethra are affected leading to dryness, discomfort, pain during sex, urinary symptoms and an increased risk of infections. Enter vaginal oestrogen. Unlike systemic hormone replacement therapy, it works locally – targeting the tissues that need it without affecting the rest of the body. But here’s where it gets interesting. Beyond easing menopause symptoms, vaginal oestrogen has been shown to reduce recurrent urinary tract infections, by up to 50% according to Dr Mary Claire Haver, MD, author The New Menopause. She notes that some clinicians now consider it a first-line treatment instead of repeated courses of antibiotics. GP and Hormone Specialist Dr Amalia Annaradnam agrees; “UTIS are common in elderly women with incidences exceeding 10% over 65 and 30% over 85. It is common reason for hospital admission and sepsis in older women and is completely preventable.”
Which raises the question; should vaginal oestrogen be used, not just during menopause but across different stages of life?
From post-partum recovery to breastfeeding-related dryness and ongoing intimate discomfort, more doctors are beginning to think the answer might be yes. We asked two hormone specialists to explain what you need to know.
What is vaginal oestrogen?
“Vaginal oestrogen is a low dose, local oestrogen therapy used to treat the genitourinary effects of oestrogen deficiency,” explains https://www.instagram.com/vanessacoppola_dnp/, Doctor of Nursing Practice, Board-Certified Menopause Practitioner and founder of Bare Soul. “It’s typically delivered as a cream, tablet, insert, or ring and works directly on oestrogen responsive tissues of the vulva, vagina, vestibule, urethra, and bladder.”
In the UK it’s typically prescribed in two forms says Dr Amalia; Estriol cream and Estradiol pessaries such as Vagifem and Vagirux which are typically less messy.
How does it work?
“From a physiological standpoint, oestrogen helps maintain vaginal epithelium thickness, elasticity, blood flow, lubrication, and a glycogen-rich environment that supports lactobacilli,” says Vanessa. “When oestrogen declines, vaginal pH rises, protective bacteria decrease, the epithelium thins, and tissues become more fragile and less well lubricated. That shift is why women may experience dryness, burning, tearing, pain with sex, urinary urgency, recurrent UTIs, and a general sense that the tissue feels less healthy or less like their own body.”
This is also where social media has both helped and hindered the conversation. “The dramatic claims that the vagina or clitoris will eat itself, shrivel up, or disappear is medically sloppy and unnecessarily frightening,” says Vanessa. “But the underlying issue it is trying to describe is real. Oestrogen loss can lead to atrophic changes involving the labia, clitoris, vestibule, vagina, urethra, and bladder.” So while anatomy doesn’t simply vanish, these tissues can become thinner, drier, less elastic, more sensitive, and less functional if hypoestrogenism is left untreated. “That distinction matters,” she stresses. “I would not use sensational language with patients, but I also would not dismiss what women are noticing. Many women are correctly perceiving real tissue changes, including loss of fullness, increased sensitivity or fragility, discomfort at the vaginal opening, reduced lubrication, and sometimes changes in arousal or orgasmic response. Vaginal oestrogen can help restore tissue quality and function locally, which is why so many women feel that it helps them get their body back.”
© VERA LAIRHow is it incorporated into an HRT Regimen?
“This is one of the most important clinical points,” says Vanessa. “Vaginal oestrogen and systemic HRT are not interchangeable therapies. Systemic oestrogen is primarily used for symptoms like hot flashes, night sweats, sleep disruption, and in some cases to support bone health. Vaginal oestrogen is used specifically for local genitourinary symptoms. Many women need both.” Dr Amalia agrees; “I often prescribe both vagifem and estriol to my patients from their 40s onwards. It can be used alone or as part of an HRT regime but for women with vaginal, vulval or bladder symptoms it is an essential part of their treatment and is often overlooked as a lot of women are embarrassed to talk about it.” Vanessa adds that even women on systemic HRT may continue to experience symptoms such as painful sex, dryness or recurrent UTIs. “That doesn’t mean her HRT failed,” she says. “It means systemic therapy doesn’t always fully address the local genital and urinary tissue changes and vaginal oestrogen may need to be layered in. For many patients, this is the difference between tolerating their body and actually feeling comfortable in it again.”
Is it safe?
“There are very few contraindications, but it should always be used under medical guidance,” says Dr Amalia. “It’s now even recommended to women with a history of breast cancer who are experiencing significant symptoms,” a point increasingly supported by specialists such as Dr Corrine Menn who made on a social media post imploring other medical professionals caring for breast cancer survivors to reassure their patients of vaginal oestrogen’s safety, as, in her words, the fear that it might trigger cancer is ‘literally ruining lives.’
That said, Vanessa stresses that treatment should always be individualised and women with unexplained vaginal bleeding should be evaluated before starting therapy.
Should every women be using it?
Not necessarily.
“There are a lot of misinformation on social media – including women using it on their face” says Dr Amalia. She also cautions against using vaginal oestrogen as a blanket treatment for recurrent UTIs in younger women without identifying the underlying cause but points out that it may be beneficial in specific situations beyond menopause including postpartum recovery where a sudden drop in oestrogen can affect healing and cause dryness.
Vanessa agrees that social media has oversimplified the conversation. “Vaginal oestrogen is not a universal solution for all women. It is most effective when tissues are oestrogen-deficient or behaving as if they are.” Breastfeeding adds another layer of complexity. “Small amounts of oestrogen can be absorbed and transferred into breast milk, so this should be considered carefully, particularly early postpartum or in women concerned about milk supply,” she says. “This is not something that should be treated casually or as a social media recommendation.”
The bottom (pun intended) line
“The larger issue is that women have been taught to normalize symptoms that are actually treatable,” says Vanessa. “Dryness, irritation, pain with sex, urinary frequency, and recurrent infections are often dismissed as part of ageing, when in reality they are commonly manifestations of a well understood and treatable condition. Vaginal oestrogen is not cosmetic, and it is not optional for many patients. It is restorative tissue therapy. Left untreated, these symptoms often progress rather than improve, and they can meaningfully impact quality of life, relationships, and overall wellbeing.”
As Vanessa notes, women deserve more precise language and better guidance. The goal is not to create fear, or minimize what women are experiencing – but to offer clear, evidence-based solutions. “Vaginal oestrogen is one of the most underutilized and most effective tools we have in menopause care. This isn’t about vanity. It’s about function, comfort, and ensuring women don’t quietly put up with symptoms that can be treated.”
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