What is the best hormone replacement therapy for vaginal atrophy?
The best hormone replacement therapy (HRT) for vaginal atrophy is local oestrogen therapy, delivered as a vaginal cream, pessary, or ring. This treats symptoms directly with minimal systemic absorption and risk.
Detailed Medical Explanation
Local oestrogen products (such as estriol or estradiol creams, tablets, or vaginal rings) are recommended first-line for moderate to severe atrophy. They restore the vaginal lining, moisture, and pH with little effect on the rest of the body. Systemic HRT may be used if there are other menopausal symptoms. All HRT should be prescribed and monitored by a healthcare provider. NHS: HRT for Vaginal Atrophy.
Clinical Context
Most women get relief with local oestrogen and experience very low risks. Those with a history of hormone-sensitive cancer should discuss options with their specialist.
Evidence-Based Approaches
UK and international guidelines support local oestrogen as the most effective and safest option for vaginal atrophy. RCOG: HRT and Atrophy.
