Not Your Mother’s Hormone Therapy

Before we begin, a quick note: I’m sharing my personal experience here — what happened to me and what I learned while working with my own doctors. I’m not a medical professional, and this isn’t medical advice. My hope is simply to shed light on a topic many women don’t hear much about and to share something that made a meaningful difference in my life. If any of this resonates with you, please talk with your own physician about what might be right for you.

Above all, be the heroine of your life, not the victim.

Nora Ephron, American writer and filmmaker known for her wit and observations about life and aging

Menopause marks a major drop in estrogen, but the changes that follow don’t stop there.

At 63, I thought I was finished worrying about estrogen.

Before my robotic BSO surgery to remove my ovaries, I simply did not feel well. I went to my doctor because of that — and because we were already monitoring a persistent ovarian cyst. The cyst ultimately led to surgery.

But one of the most important things I learned during that process had nothing to do with the cyst itself.

It had to do with estrogen.

I learned that I needed localized vaginal estrogen cream — specifically estradiol. It’s available by prescription.

No one had ever explained to me clearly that after menopause, the body continues to respond to low estrogen in ways that are not merely inconvenient, but medically significant.

Localized estrogen strengthens thinning vaginal tissue, improves lubrication, reduces discomfort with intimacy, and significantly lowers the risk of recurrent urinary tract infections.

That thinning can become fragile enough that you can have slight bleeding and/or discharge.

Starting localized estrogen made a tremendous difference for me.

And beyond improving those symptoms, I learned something even more important: low estrogen increases the risk of urinary tract infections as we age.

UTIs become far more common after menopause — and often more serious. In the video below, urologist Dr. Kelly Casperson cites estimates suggesting that 50% to 80% of postmenopausal women experience genitourinary symptoms related to estrogen loss. Those changes increase vulnerability to urinary tract infections, which can escalate quickly and sometimes require hospitalization.

I did not have a UTI. But I was surprised to learn how common and serious they can become after menopause — especially after watching family members struggle with them in their later years.

That’s another important reason doctors recommend localized estrogen — and one that rarely gets discussed.

This small addition to my routine has made an enormous difference.

Please talk to your doctor if this resonates — or even if you’re simply curious.

This Is Not Your Mother’s Hormone Therapy

Many of our mothers were prescribed systemic hormone therapy decades ago. Later studies — particularly the Women’s Health Initiative — raised concerns about certain combined systemic treatments. That history understandably left many women wary of estrogen in any form.

But low-dose localized vaginal estradiol is different.

This is not systemic hormone therapy circulating throughout the entire body. Localized estradiol absorbs minimally into the bloodstream. Because of that, many physicians consider it safe for long-term use and do not associate it with the same risk profile as systemic hormone therapy for most women.

My doctor prescribes this routinely and instructs her patients to continue using it long term. Some of those women have used it for decades. Some are in their 90s.

For me, this has been safe and truly a game changer.

Vaginal Estrogen Show and Tell Video

Below is a video from urologist Dr. Kelly Casperson explaining why she recommends vaginal estrogen for women over 50. In the clip, she says to use it “after 50 years old… twice a week until you die.”

I found this explanation incredibly helpful. It reinforced what my doctors were already telling me and clarified the broader health implications of localized estrogen therapy.

One important note: this video was filmed before 2026, when the FDA removed the boxed warning language from low-dose vaginal estrogen products. Those warnings were originally based on systemic hormone therapy data. Because low-dose vaginal estrogen absorbs minimally into the bloodstream, many physicians had long considered it safe. The updated FDA guidance now reflects that distinction.

Several OB-GYNs I consulted at Kaiser Permanente confirmed this to me.

I wish someone had told me this years ago.

Questions about my symptoms? I’m an open book. Just drop me a personal note and I’d be happy to relate my experience.