Version July 2025
| Preparation | United States trade name | Available strength(s) | Suggested regimen | |
| Estrogens | ||||
| Conjugated estrogen | Vaginal cream* | Premarin | 0.625 mg conjugated estrogens per g of cream | 0.5 g of cream intravaginally administered once daily for 2 weeks, then reduce to twice weekly¶; dose may be adjusted according to patient's symptoms and clinical response (range: 0.5 to 2 g of cream). |
| Estradiol | Vaginal cream* | Estrace | 100 mcg estradiol per g of cream | 0.5 g of cream intravaginally administered once daily for 2 weeks, then reduce to twice weekly¶; dose may be adjusted according to patient's symptoms and clinical response (initial range: 0.5 to 4 g of cream; maintenance range: 0.5 to 1 g of cream). |
| Vaginal insert | Imvexxy | 4 mcg or 10 mcg estradiol per vaginal insert | Insert 1 softgel intravaginally once daily for 2 weeks, followed by twice weekly. Initial dose depends on clinical severity and patient preference; dose may be increased or decreased according to clinical response. | |
| Vagifem, Yuvafem | 10 mcg estradiol per vaginal insert | Insert 1 tablet intravaginally once daily for 2 weeks, followed by twice weekly. | ||
| Vaginal ring | Estring | 7.5 mcg estradiol per day, released over 90 days | Ring is inserted into the vagina by the patient or clinician. Ring is removed and replaced with a new ring every 90 days. | |
| DHEAΔ | ||||
| Prasterone | Vaginal insert | Intrarosa | 6.5 mg prasterone per vaginal insert | Insert 1 suppository intravaginally once daily. |
DHEA: dehydroepiandrosterone; GSM: genitourinary syndrome of menopause.
* Vaginal estrogen creams are supplied with an applicator marked with dose calibrations so the patient can measure the prescribed amount of cream.
¶ Our practice differs from the manufacturer's product information; refer to UpToDate topic for further information.
Δ While approved only for the indication of GSM-associated dyspareunia, studies have also demonstrated improvement in vaginal dryness. This is discussed in related UpToDate content.
