Key takeaways:
Vaginal estrogen products are an effective treatment for vaginal menopause symptoms. These medications are available only with a prescription.
Vaginal estrogen products include creams, rings, and inserts. They all work similarly well for relieving vaginal menopause symptoms. But some treat more symptoms than others.
Over-the-counter (OTC) estrogen creams are not a substitute for prescription vaginal estrogen. OTC creams don’t work for menopause symptoms, and there’s limited evidence regarding their safety.
Menopause — a permanent end to menstrual periods — is an ordinary part of life. But changing hormones during menopause can cause bothersome vaginal and sexual symptoms. Some of these symptoms may include dryness, irritation, and pain during sex.
Over-the-counter (OTC) vaginal moisturizers and lubricants might help relieve some of these symptoms. Topical estrogen products — such as vaginal estrogen cream — are also potential options. But these vaginal estrogen products are only available as prescriptions from a healthcare professional. In addition to creams, vaginal estrogen medications are available as rings, inserts, and tablets that are inserted into the vagina.
All of these vaginal estrogen products appear to be similarly effective for vaginal menopause symptoms. They also have a very low risk of serious side effects, such as blood clots and breast cancer.
In this article, we’ll discuss vaginal estrogen prescriptions and OTC options.
Topical estrogen creams
The two main estrogen creams for vaginal dryness are Premarin Vaginal Cream (conjugated estrogens) and Estrace (estradiol). Estrace comes as both a brand-name and lower-cost generic medication. Premarin Vaginal Cream is available only as a brand-name medication.
Both vaginal creams work in the same way, even though their active ingredients are different. And they have similar side effects. Often, the choice between the two comes down to personal preference and cost.
Premarin Vaginal Cream and Estrace both come with applicators. But it’s also common for people to use their fingers to apply the cream. For exact directions on how to use Premarin Vaginal Cream or Estrace, talk to your prescriber. How frequently you use your cream typically depends on your symptoms.
Vaginal estrogen rings
There are two available vaginal estrogen rings: Femring (estradiol acetate) and Estring (estradiol). Both medications come as brand-name-only medications and provide 3 months of estrogen within one vaginal ring.
One of the main differences between Femring and Estring is what symptoms they can treat. Femring is FDA-approved to treat vaginal and vasomotor (hot flashes) menopause symptoms. Estring can only treat vaginal symptoms. This is because Femring contains a higher dose of estrogen than Estring.
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If you only have vaginal menopause symptoms, it’s recommended to try a low-dose vaginal estrogen, such as Estring, first. That’s because these vaginal estrogens have a lower risk of side effects than estrogen products that affect your whole body, such as Femring.
Vaginal estrogen tablets and inserts
Vaginal estrogen tablets and inserts all contain the active ingredient estradiol. They include:
Imvexxy inserts
Vagifem tablets
Generic estradiol tablets
Yuvafem tablets
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Imvexxy is a brand-name-only medication. Vagifem is available as both a brand-name and generic medication. Yuvafem is a popular branded generic version of Vagifem.
One difference between these vaginal tablets and inserts is what they’re approved to treat. Imvexxy is approved to help relieve pain during sex that’s caused by menopause. Vagifem and its generics are approved to treat multiple vaginal menopause symptoms. These can include vaginal dryness, vaginal irritation, and pain during sex.
Imvexxy also comes in different doses than Vagifem. Imvexxy comes as both a 4 mcg and 10 mcg insert. Vagifem and its generics only come as 10 mcg tablets. What’s more, you’ll need to insert Imvexxy with your fingers. But Vagifem comes with applicators you’ll use to insert the tablet.
Despite these differences, Imvexxy and Vagifem have similar side effects. And the recommended maintenance dosages are the same for both: Insert 1 vaginal insert or tablet twice weekly.
Can you purchase estrogen cream OTC?
Yes, you can purchase estrogen creams OTC. But these products are used differently than prescription vaginal estrogens. OTC estrogen creams are meant to be applied to the skin, such as on the face.
What’s more, these products are typically marketed for wrinkle reduction — not for menopause symptom relief. The research on whether OTC estrogen creams work for wrinkles or are safe to use is limited and dated.
Don’t substitute OTC estrogen creams for prescription estrogen products. If you want to explore hormone-free menopause medications, speak with your healthcare team. There are several options available. Some work for vaginal symptoms, and others provide hot flash relief.
Is there a natural alternative to estrogen cream?
Yes, there are natural menopause products available.
However, as with OTC estrogen creams, the evidence supporting their use and safety isn’t strong. And they may interact with other medications you’re using. So before purchasing any menopause supplements, ask your prescriber and pharmacist about them.
One option you may want to consider trying is an OTC personal lubricant. These products are medication-free and are generally recommended to use before trying any estrogen product (even vaginal estrogens). If you have questions about these options, talk to a healthcare professional.
Frequently asked questions
To apply estrogen cream with your finger, follow these steps:
Wash your hands with soap and water.
Measure your prescribed dose using the applicator that comes with your cream.
Squeeze the cream out of the applicator onto your finger.
Use your finger to insert the cream into your vagina.
Consider also applying a small amount of cream to your vulva (the area outside of your vagina).
Wash your hands again with soap and water after you’re done.
It takes all vaginal estrogen products, including creams, about 2 to 3 months to reach their full effects. Apply your cream according to its prescribed directions to make sure you receive the full benefit.
To apply estrogen cream with your finger, follow these steps:
Wash your hands with soap and water.
Measure your prescribed dose using the applicator that comes with your cream.
Squeeze the cream out of the applicator onto your finger.
Use your finger to insert the cream into your vagina.
Consider also applying a small amount of cream to your vulva (the area outside of your vagina).
Wash your hands again with soap and water after you’re done.
It takes all vaginal estrogen products, including creams, about 2 to 3 months to reach their full effects. Apply your cream according to its prescribed directions to make sure you receive the full benefit.
The bottom line
Vaginal menopause symptoms include vaginal dryness and pain during sex. There are several vaginal estrogen products available to help relieve these symptoms. Examples include creams, rings, and inserts. All work similarly to relieve bothersome vaginal menopause symptoms. But some treat more symptoms than others. Vaginal estrogen creams are prescription-only medications. OTC estrogen creams work differently and aren’t meant to treat menopause symptoms.
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References
Abraham, C. (2024). Experiencing vaginal dryness? Here's what you need to know. The American College of Obstetricians and Gynecologists.
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Kaufman, M. R., et al. (2025). Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025). The Journal of Urology.
Lindahl, S. H. (2014). Reviewing the options for local estrogen treatment of vaginal atrophy. International Journal of Women’s Health.
Mayne Pharma. (2025). IMVEXXY- estradiol insert [package insert]. DailyMed.
Millicent US. (2024). FEMRING- estradiol acetate ring [package insert]. DailyMed.
Pfizer Laboratories Div Pfizer. (2025). ESTRING- estradiol system [package insert].
Rzepecki, A. K., et al. (2019). Estrogen-deficient skin: The role of topical therapy. International Journal of Women's Dermatology.
The Menopause Society. (2025). Genitourinary syndrome of menopause.
The Office of the Federal Register. (2025). § 310.530 Topically applied hormone-containing drug products for over-the-counter (OTC) human use. National Archives and Records Administration.
U.S. Food and Drug Administration. (2023). Menopause.
