Every Woman Should Be On Vaginal Oestrogen
There. I Said It.
Most women have never heard of it. Most GPs aren't offering it. And the ones who have been prescribed it often aren't using it correctly.
Vaginal oestrogen is the most underused, most underprescribed, most life-changing treatment in the menopause space. In this episode, Kylie makes the case for why she believes every woman in perimenopause and menopause should be using it — and gives you everything you need to understand it, use it correctly, and advocate for yourself with your doctor.
This is the conversation every woman in perimenopause and menopause needs to hear.
In This Episode
What vaginal oestrogen actually is — and why it's not the same as systemic MHT
The full symptom picture beyond dryness — including recurrent UTIs and bladder urgency
Why GSM is progressive — and why starting early matters
The safety profile — why women who can't use systemic MHT may still be candidates
Products available in Australia right now — Ovestin, Vagifem, Vagirux, Intrarosa
How to actually apply it — including the finger method nobody talks about
How long it takes to work and how to stay consistent
When to start and who it's for — including women in their early 40s
How to talk to your GP and advocate for yourself if you're dismissed
What to do if MHT isn't for you — your toolkit still matters
Why Every Woman Should Be On Vaginal Oestrogen
Unlike hot flushes and night sweats which often ease over time, the genitourinary changes of menopause — known as GSM (Genitourinary Syndrome of Menopause) — are progressive. They get worse the longer oestrogen is absent, not better.
And here's the piece most women don't know: once the tissue degrades significantly, it doesn't fully recover on its own. This is why starting early and staying consistent matters so much.
"I hate the term vaginal atrophy. It's clinical and depressing and it makes women feel broken. Your tissues are changing because they're not getting the oestrogen they need. And we can fix that." — Kylie
The Full Symptom Picture
Most women know about vaginal dryness. Most don't know about everything else connected to GSM:
Vaginal dryness and discomfort — day to day, not just during sex.
Painful sex — dyspareunia. Often leads to avoidance, which makes the tissue changes worse.
Vaginal irritation, itching, burning — frequently misdiagnosed as thrush or a skin condition.
Recurrent UTIs — as the urethral tissue thins and loses its protective barrier, bacteria get in more easily. Women on their fourth UTI in a year are often never told that vaginal oestrogen could break the cycle.
Bladder urgency and leaking — the bladder and urethra are oestrogen-dependent too. Urgency, frequency, and stress incontinence are all connected.
Pelvic floor changes — the tissue changes affect the whole pelvic floor environment.
The Safety Profile — Why This Is Different From Systemic MHT
Vaginal oestrogen is local — it works directly in the tissue where it's needed, with minimal systemic absorption. The doses are very low and very little gets into the bloodstream.
This means the risk profile is completely different from systemic MHT. Women who have been told they cannot have HRT due to breast cancer history, clot risk, or cardiovascular history may still be candidates for vaginal oestrogen. This is a conversation worth having with your doctor — not an automatic no.
It is not the same as systemic MHT, and it does not replace it if systemic support is needed. But it also does not require the same level of risk assessment.
Products Available in Australia
Ovestin cream — oestrogen cream applied vaginally. Widely available on prescription.
Vagifem / Vagirux — small pessaries inserted vaginally. Some women find these easier and less messy than cream.
Intrarosa — contains DHEA (prasterone) which converts to both oestrogen and testosterone locally. A newer option worth discussing with your doctor.
All are available on prescription — from your GP or a specialist. If your GP is unfamiliar with the options, ask for a referral to a gynaecologist or a GP with a specific menopause interest.
How to Actually Use It — The Practical Conversation Nobody Has
Most products come with an applicator — but many women find them uncomfortable, difficult to position correctly, or a barrier to consistent use. Consistency is everything with vaginal oestrogen.
The finger method: Clean finger, small amount of cream, insert and apply directly to the vaginal walls. This is often more comfortable, more controlled, and more effective at getting the cream exactly where it needs to go.
How often: Typically every night for the first two weeks (the loading dose), then twice a week for ongoing maintenance. Always follow your specific prescription and GP guidance.
How long to see results: Most women notice improvement within 4 to 6 weeks. Significant improvement by 3 months. It is not an overnight fix — consistency over time is what creates the change.
This is ongoing care, not a one-off treatment. Like brushing your teeth. The tissue needs ongoing oestrogen support to stay healthy.
"I know talking about putting cream on your vagina feels a bit weird. But you know what's weirder? Suffering unnecessarily for years because nobody told you this was an option. Get comfortable with it. Your body deserves the care." — Kylie
When to Start and Who It's For
Women in early perimenopause — ideally start before significant tissue changes occur
Women in their early 40s — yes, absolutely appropriate
Women already post-menopause who've never used it — not too late, start now
Women on systemic MHT — vaginal oestrogen can be used alongside, they address different things
Women who can't or won't use systemic MHT — vaginal oestrogen may be the most accessible option for GSM symptoms
Women who've been told they're 'too young' — GSM symptoms can begin in the early 40s
How to Talk to Your GP
Many GPs are not proactively offering vaginal oestrogen — you may need to ask. Here's what to say:
"I've been experiencing [vaginal dryness / recurrent UTIs / bladder urgency / painful sex] and I'd like to discuss vaginal oestrogen as a treatment option."
If your GP is dismissive or unfamiliar, ask for a referral to a gynaecologist or a GP who has a specific interest in menopause medicine.
You should not have to fight for this. But sometimes you do. And you are worth fighting for.
If MHT Isn't For You — Your Toolkit Still Matters
Pelvic floor physiotherapy — genuinely life-changing for bladder and pelvic floor symptoms. Kylie recommends this strongly.
Good quality lubricants — silicone-based for sex, water-based for daily comfort. Not all lubricants are created equal.
Staying sexually active — regular sexual activity maintains blood flow to the tissue and slows the rate of change.
Gut health and nutrition — the anti-inflammatory foundation supports tissue health everywhere in the body.
The lifestyle foundation — regardless of what you decide about hormones, the basics matter.
Resources & Next Steps
Ready to build the lifestyle foundation that supports everything we talked about today?
The Hormone Reset — $97 → myhormonehub.com/hormone-reset
The Hormone Reset is Kylie's 28-day program — the food, gut, and hormone foundation that works alongside any decision you make about MHT.
Please Share This Episode
This one could genuinely change someone's life. The woman who has been silently suffering with painful sex. The one on her fifth UTI this year. The one who thinks this is just what getting older feels like.
Send it to her. Send it to your GP if you want to. Post it in your group chat. Every woman deserves this conversation.
Big love,
Kylie x
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Transcript
Hello, and welcome to The Hormone Hub. I'm your host, Kylie Pinwill, and today I'm gonna say something that might surprise you, and then I'm gonna spend the next 20 minutes or so backing it up with actual evidence. Every woman in perimenopause and post-menopause should be on vaginal estrogen. Every single one.
So not every woman needs systemic M- MHT or traditional HRT. That's a personal decision with a lot of varying factors. But vaginal estrogen, I think this is a non-negotiable for almost all of us. And yet most women have never heard of it, most GPs aren't offering it, and the [00:01:00] ones who have been prescribed it often aren't using it correctly.
So today we're going there. What it is, what it does, who needs it, how to actually use it, and how to have the conversation with your doctor if they look at you blankly. Let's go.
When our estrogen declines, the vaginal tissue, bladder lining, and urethra all lose their estrogen supply. So these tissues are estrogen-dependent, and they need it to stay healthy, elastic, well-lubricated.
So the medical term is the genitourinary syndrome of menopause, or just GSM. So this is the old-school take on vaginal atrophy, which I just think is an appalling description of what's going on. It's clinical, it's depressing, and it makes us feel broken, dried out and, you know, over.
But let's call it what it is, your tissues are changing because they're not getting the [00:02:00] estrogen they need, and we can fix that. So unlike hot flushes and night sweats, which often ease over time once you're post-menopausal, GSM is progressive. So this means that it gets worse the longer that estrogen is absent, not better. It doesn't even out. And here's the critical piece. So once the tissue degrades significantly, it doesn't fully recover on its own. So this is why starting early and staying consistent really matters. So I've been talking to women who've been suffering for years, thinking that sex is just painful now, everything feels dry and, it doesn't have to be.
So most of us know about vaginal dryness. Now, what we don't talk enough about, I think, is everything else that's connected to it. So vaginal dryness and discomfort. So it's not just vaginal, it's [00:03:00] also your labia, it's your clitoris, it's all of the, the tissues and the structures, you know, associated with your genital region.
So it's day in, day out, and it's not always just during sex. Painful sex 100% is a, a very obvious symptom, and often leads to avoidance, which potentially can just make things worse as well, you know, the old use it or lose it kind of situation. So if we have any irritation, any itching, any burning, this is often misdiagnosed as thrush or a skin condition, you know, recurrent UTIs, and this is a big one that most people don't connect. As the urethral tissue thins and loses its protective barrier, bacteria can get in more easily. So, you know, women who are having two, three, four UTIs in, say, a year are often never told that vaginal [00:04:00] estrogen could actually break this cycle.
Any bladder urgency and leaking. So the bladder and the urethra are estrogen-dependent too. So that urgency, that frequency to, to urinate, stress incontinence. So, you know, sneezing and doing a little wee or just moving about, it's all connected. And, naturally with these changes in our hormones come pelvic floor changes.
So the changes in the tissue affect the whole pelvic floor environment. I speak to women who've been on antibiotics either continually or four times in one year for UTIs, and no one has mentioned vaginal estrogen to them. And that's why I really wanted to have this conversation today.
So vaginal estrogen is different from the systemic MHT or HRT. So traditional kind of HRT or regular HRT for, you know, want of a better [00:05:00] word, it's taken in pill form or it's a patch that's absorbed through your skin. And I'll, I'll do a follow-up episode, in our next episode on the benefits of those or the- I guess, you know, the education around what is available to us.
But today, yeah, focusing in on this vaginal estrogen, which is local, and it just works on the, directly on the tissues where it's needed. Your s- what we call systemic absorption, so it being absorbed back into your bloodstream, is very little. So the doses are really low. It's very targeted specifically to that genital area, and very little, you know, comes back into your bloodstream.
So this means that the risk profile is completely different from regular HRT or MHT. And when I'm talking about HRT or MHT, so hormone replacement therapy, we all know what that [00:06:00] means. But the correct terminology these days is MHT. So we're not replacing the hormones we've lost. It's menopause hormone therapy.
So it's like topping up your hormones. We're not replacing hormones. So women have been told that they can't take HRT due to, you know, whether it's breast cancer history, clot risk, cardiovascular history, may still be candidates for vaginal estrogen because of this local action.
So this is a conversation that is 100% worth having with your doctor. It's not an automatic no for you. It is not the same as HRT. It does not replace systemic MHT if that's needed, but it also doesn't require the same level of risk assessment. So if your doctor has said you can't have HRT and therefore doesn't offer you vaginal estrogen as an alternative for these specific symptoms, ask for it.
Push. You deserve to have that conversation, and the research [00:07:00] is 100% there. So typical products that we see for vaginal estrogen are the Ovestin cream. So this is a cream applied vaginally, widely available. We've also got things like Vagifem and Vagirux, which are small pessaries that are inserted vaginally.
Some women find these easier, less messy. But if you are feeling quite sensitive already the thought of inserting a plastic applicator can be terrifying . There's also a newer option that's out is Intrarosa, which contains DHEA, which converts to both estrogen and testosterone locally.
So this is definitely worth knowing about, it's a newer option available to us. So patches in Australia are in, in short supply now for systemic HRT, but vaginal estrogen products are generally pretty well-stocked. All of these are [00:08:00] available on prescription through either a GP or gynecologist, but talk to your GP. Start there. If they're not familiar with the system, with the options available to you, ask for a referral to either a menopause specialist or a gynecologist who is, because we definitely want to get on top of this.
So how we actually use it. So this is the practical conversation that nobody is having with us. And this is the section that a lot of podcasts or a lot of, you know, when we're talking about HRT, skip over. We're not skipping it.
All right. So most products come with an applicator. So like I said, if you're already feeling dry and quite sensitive, these can be quite confronting and uncomfortable, and not always easy to use correctly either.
So what I recommend, and I... There was a great, it was actually, I don't know, a YouTube video or something I, I saw. So she was [00:09:00] a gynecologist, so she put, you know, the finger method, right? So wash your hands and then take on your index finger, from the tip of your finger up to sort of just past or probably halfway between that first and second finger joint, that's how much cream we want.
And then we want you to take that finger, insert it and directly apply it to the vaginal walls. So this is often more comfortable, more controlled, and more effective of getting that cream where it needs to go. So we want to insert it internally, rub it around the vaginal walls. Then anything left over on your finger, we want you to rub that around your labia, rub it around your clitoris, rub it around your urethra area.
Anywhere where this cream needs to go, you can put it. So the applicator can be a barrier to consistent use. And when it comes to using this vaginal estrogen, [00:10:00] consistency is everything. And how often we use it, I think this is often not always correctly explained or prescribed either.
So most women notice an improvement within four to six weeks, and significantly by three months, but it's not overnight, so consistency is key. So what we wanna do is what we call, like, I guess, like, a loading dose. So use it every night for two weeks. So nighttime works well because you're on your way to bed and you're gonna lie down. It's not gonna feel like it's dripping out. So rub it everywhere you feel it needs to go, every night for two weeks. Then we want to use it twice a week ongoing until the end of time. Okay? So pick a night, like whether it's Wednesday and Sunday or Thursday and Monday, whatever works best for you, just pick two nights and, and it's that consistency over time which creates the greatest change.
So it's, it's ongoing. It's like brushing [00:11:00] your teeth. That tissue needs ongoing estrogen support. It's certainly safe to have sex before and after you've used it. Up to you, use your discretion. I know about talking about putting cream in your vagina feels weird, but you know what's weirder is suffering unnecessarily for years because no one told you that this was an option.
So get comfortable with it. You know, it's part of your self-care, and you, your body deserves that care. So when we would start taking this is ideally we would start in perimenopause, so before those significant tissue changes occur, not after they occur because it's harder to bring them back. Okay? So we want to get in there before the damage is done. So it's absolutely appropriate for women in their early 40s. Women who are already post-menopausal and who've never used it, it's not too late to start. So start now. [00:12:00] So improvement is still possible. So women on systemic MHT, vaginal estrogen 100% can be used alongside.
So if you are taking estrogen and progesterone or testosterone or any combination of those, if we think of this as a separate treatment to that because it has a different purpose and it has a different act on your body. So women who can't or won't or don't want to use systemic, traditional HRT, vaginal estrogen still might be your best and most accessible option.
There are, you know, like if we want to go natural, there are some good products out there. So there's been a lot of research with sea buckthorn, and, there's a few... I recommend V For Me Smooth, is one of my favorites. But certainly if you can use the [00:13:00] estrogen, why wouldn't you, honestly?
Also women who think they're too young to need it. Okay. So perimenopause symptoms, including those genitourinary syndrome of menopause, this can start in your early 40s. So if you are prone to UTIs, if you're prone to dryness, if you're prone to feeling uncomfortable in jeans or sitting or, if you've got the wrong pair of knickers on, 100% this is your sign that this would be a good idea for you. So when it comes to sort of asking your GP, a lot of GPs are not proactively offering it, so you may need to ask, and that's okay. You know, you are your best advocate for your own body.
You can say things like, "I've been experiencing vaginal dryness. I've been experiencing recurrent UTIs. I feel like I always need to go to the toilet. Sex is painful. I'd like to discuss vaginal estrogen as a treatment [00:14:00] option." Okay. So that's a really, you know, you've stated the problem and you're giving them a solution.
Now, if they're not familiar or if they're a bit dismissive, ask for a referral to a gynecologist or find a GP who has an, an interest in menopause. Like I said, be your own advocate. No one's gonna manage your health as well as you will when you're armed with the right information. And I think we are 100% a different generation to women who've come before us.
We do say what we want. We are much better at speaking up for ourselves. But unfortunately, we have also been conditioned not to. We've been conditioned to be a good girl. We should be seen and not heard and all that other bullshit. So, ask for what you deserve. You shouldn't have to fight for this, but you are 100% worth fighting for.
Okay. So if- MHT isn't for you, what you've got in your [00:15:00] toolkit still matters. Okay, so vaginal estrogen aside, the lifestyle foundations are still non-negotiable regardless of any hormone decisions. A pelvic floor physio and can be- or a pelvic floor osteo can be genuinely life-changing for bladder and pelvic floor symptoms.
I highly recommend this. I saw a, an osteopath who specializes in pelvic floor. It was an internal treatment, and it was so gentle and so relaxed and, she basically released all of the tension that I was holding. So I was basically reefing my whole uterus over to one side of my body.
She released all of that, you know, and it was very gentle. She asked permission. She told me what was gonna happen the whole way through. And like, it wasn't as bad as I thought. I would rather do that than have a pap smear, to be honest, although they have changed too. So highly recommend seeing a pelvic floor physio [00:16:00] or osteopath who recommends in pelvic floor.
Good quality lubricants, they are not all based equally. We want silicon-based lubricants, specifically for more comfortable sex, better enjoyment, and we want water-based lubricants if you do need something just daily to feel more comfortable in pants and sitting down, you want to look for a water-based. Please don't use coconut oil or anything n-not designed for this purpose.
Stay sexually active. So regular sex, whether that's solo or with a partner, no one needs to miss out. This helps maintain blood flow to all the tissues, and it slows the rate of change as well. So MHT is one tool in your toolkit, but the toolkit matters regardless of what you decide about hormones.
So I genuinely believe this episode- can be life-changing. So for the woman who has been suffering [00:17:00] silently with painful sex or is on her multiple UTI this year or thinks this is just what getting older feels like, she needs to hear this.
Because this also, just let me say, will fast-track you into a nursing home as well. One of the biggest reasons for admission for women into a nursing home is incontinence and urinary issues. So, you know, we wanna get on top of this.
So please share this. Send it to your GP if you want. Send it to your best friend. Uh, post it in your group chat. And if you want to start building the lifestyle foundations that supports everything that we talked about today, the Hormone Reset is just $97. It's waiting for you. I'll put the link in the show notes. Big love, and I'll see you in the next episode.