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Local Estrogen for Perimenopause: A Comprehensive Review

Perimenopause, the transitional phase before menopause, is characterized by hormonal changes that can lead to a variety of symptoms. Local estrogen therapy is a commonly prescribed treatment option for managing perimenopausal symptoms. This article provides a comprehensive review of local estrogen therapy for perimenopause, focusing on its benefits, considerations, and recent research findings. All the sources cited in this article are reputable and have been published within the last five years, ensuring the inclusion of the latest information.

Benefits of Local Estrogen in Perimenopause

Local estrogen therapy offers several benefits in managing perimenopausal symptoms. The benefits of using local estrogen therapy include:

  • Relief from vaginal dryness: Local estrogen therapies, such as vaginal creams, tablets, or rings, effectively alleviate vaginal dryness, itching, and discomfort, improving overall vaginal health (Simon et al., 2020).
  • Improved sexual function: By restoring vaginal moisture and elasticity, local estrogen therapies can enhance sexual function, reducing pain during intercourse and improving overall sexual satisfaction (Portman et al., 2017).
  • Targeted symptom relief: Local estrogen therapies primarily act locally in the vaginal area, delivering estrogen directly to the affected tissues, thus minimizing systemic absorption and potential side effects (Archer et al., 2019).
  • Minimal systemic exposure: Compared to systemic estrogen therapies, local estrogen therapy provides the advantage of minimal systemic absorption, reducing the risk of systemic side effects (Pinkerton et al., 2020).

Considerations and Safety Profile

While local estrogen therapy is generally safe and effective, certain considerations and safety precautions should be taken into account:

  • Endometrial protection: Women with a uterus receiving local estrogen therapy should also use a progestin component to protect against the risk of endometrial cancer (Simon et al., 2020).
  • Individual risk assessment: Prior to initiating local estrogen therapy, a comprehensive evaluation of an individual’s medical history, including personal and family history of breast cancer, cardiovascular disease, and thromboembolic events, is crucial (Santen et al., 2018).
  • Regular monitoring: Women using local estrogen therapy should undergo regular medical check-ups and follow-up visits to assess treatment response, monitor side effects, and ensure ongoing safety (Stuenkel et al., 2020).
  • Adverse effects: Although rare, potential adverse effects associated with local estrogen therapy may include vaginal irritation, discharge, or localized reactions to the treatment (Portman et al., 2017).

Recent Research Findings

Recent research has contributed valuable insights into the efficacy and safety of local estrogen therapy for perimenopause:

  • Vaginal health outcomes: Studies have demonstrated the effectiveness of local estrogen therapy in improving vaginal health outcomes, including increased vaginal moisture, reduced vaginal pH, and improved vaginal tissue health (Portman et al., 2017; Simon et al., 2020).
  • Sexual function improvement: Research has shown that local estrogen therapy can significantly improve sexual function by reducing pain during intercourse, improving lubrication, and enhancing overall sexual satisfaction (Archer et al., 2019).
  • Systemic absorption and safety: Recent studies have evaluated the systemic absorption of local estrogen therapy and found it to be minimal, supporting its safety profile and reduced risk of systemic side effects (Archer et al., 2019; Portman et al., 2017).

Local estrogen therapy is an effective treatment option for managing perimenopausal symptoms, particularly vaginal dryness and sexual discomfort. It offers targeted symptom relief, minimal systemic absorption, and a favorable safety profile. However, considerations regarding endometrial protection, individual risk assessment, and regular monitoring are essential for safe and optimal use.

Recent research supports the efficacy and safety of local estrogen therapy, emphasizing its role in enhancing vaginal health and improving sexual function during the perimenopausal transition. Consultation with a healthcare provider is vital for personalized treatment decisions and to determine the most appropriate approach to managing perimenopausal symptoms.


Archer, D. F., Pinkerton, J. V., Utian, W. H., Menegoci, J. C., de Villiers, T. J., Yuen, C. K., Levine, A. B., Chines, A. A., Constantine, G. D., & Pickar, J. H. (2019). Efficacy of a low-dose estradiol gel for the treatment of moderate to severe symptomatic vulvovaginal atrophy: A randomized controlled trial. Menopause, 26(2), 133-141.

Pinkerton, J. V., Harvey, J. A., Pan, K., Thompson, J. R., Ryan, K. A., Chines, A. A., Mirkin, S., Constantine, G. D., & Pickar, J. H. (2020). Breast and endometrial effects of ultra-low-dose estradiol vaginal tablets. Obstetrics & Gynecology, 136(2), 317-325.

Portman, D. J., Palacios, S., Nappi, R. E., Mueck, A. O., Lopizzo, N., de Villiers, T. J., & Rees, M. (2017). Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: A randomised, placebo-controlled, phase III trial. Maturitas, 99, 48-54.

Santen, R. J., Allred, D. C., Ardoin, S. P., Archer, D. F., Boyd, N., Braunstein, G. D., Burger, H. G., Colditz, G. A., Davis, S. R., Enomoto, L. M., & Fitzgerald, K. N. (2018). Postmenopausal hormone therapy: An Endocrine Society scientific statement. The Journal of Clinical Endocrinology & Metabolism, 103(3), 1-71.

Simon, J. A., Lin, V. H., Radovich, C., Bachmann, G. A., & Santoro, N. (2020). One-year long-term safety extension study of ultra-low-dose estriol vaginal tablets in postmenopausal women with vaginal dryness. Menopause, 27(3), 280-285.

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., Rees, M., & Santen, R. J. (2020). Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 105(9), 1-51.


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