Adult SexEd


Vaginal Estrogen


Let’s talk specifically about low dose vaginal estrogen therapy.

It usually causes confusion – but I’m here to tell you that at least for vaginal estrogen, we can clear up confusion with just a little bit of education. Pelvic hormone therapy is a wonderful option for most women!

So, let’s get into my professional hot takes on vaginal estrogen.

Firstly, everyone who wants vaginal estrogen should have access to it.

Contrary to what the pamphlet tells you, vaginal estrogen is not dangerous or harmful. Other countries understand this. It’s over the counter in the United Kingdom and Norway! If you don’t have a physician or prescriber available to you, see below or use THIS CODE for an online consultation.

Second, vaginal estrogen can be considered as preventative healthcare, just like skincare.

Think about it this way: do you wait until your skin is cracked and dry before applying lotion? I bet you don’t. So why wait until you experience symptoms of GSM (genitourinary syndrome of menopause) to start using vaginal estrogen?

What are the symptoms of GSM?

Genitourinary syndrome of menopause (GSM) is defined as a collection of symptoms and signs caused by hypoestrogenic changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder that occur in menopausal patients.

Genital symptoms:

  • dryness
  • burning
  • irritation

Sexual symptoms:

  • lack of lubrication
  • burning
  • impaired function

Urinary symptoms:

  • urgency
  • dysuria
  • recurrent urinary tract infections

People may present with some or all of the signs and symptoms. GSM is very common (up to 50-80% of women post menopause can experience these symptoms) and most don’t know these symptoms can be as a result of low estrogen “because menopause was years ago”. But you never STOP having low estrogen levels, and the symptoms can progress with time past your last period. GSM can really start to be noticeable 5-10 years AFTER the onset of menopause, which in America the average age is 51.

Even women with a history of breast cancer can use vaginal estrogen products but I always instruct them to clear it with their oncologist as each person is unique in their own history, especially if you are on an aromatase inhibitor.

Remember: Many of the warnings on the box of vaginal estrogen products are wrong and don’t apply to this low dose version of estrogen. Vaginal estrogen is incredibly safe. The American College of Gynecologists (ACOG) has been trying to remove the warnings for years as the warnings needlessly scare many women off of the products.

Finally, let’s talk about cost.

No one should pay more than $100 for their vaginal estrogen and there are many ways to pay less than that. These days, paying cash rather than using insurance is often cheaper.

Here are a few other ways you can try to get the cost of your vaginal estrogen down:

  1. Use the GoodRx App:
    • Type in estradiol 0.01% cream 42 g tube
    • Enter your zip code
    • GoodRX will show you the cash price you can pay at the pharmacies in your area.

  2. Transfer your prescription to Amazon Pharmacy if you can’t get a good deal locally.
    • It’s around $28 for a tube of estradiol in the US

  3. Transfer your prescription to Cost Plus Drugs. Again, they cut out the expensive middle man (your insurance) to bring you very low prices.

  4. Go online to (use this link to get $20 off your first shipment)
    • This is a great option if you don’t have a healthcare provider writing a prescription for you
    • Interlude is dedicated solely to providing vaginal estrogen
    • All you do is complete an online medical form with information about your symptoms and health history, and then the doctors at Interlude will get in touch with you
    • They also do free shipping with discreet packaging
    • Use MY CODE for $20 off your first shipment

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I'm Dr. Kelly Casperson

I’m the sister, urologist, sex expert and friend you never knew you needed….until now. I’m a board certified urologist — that makes me an expert of the pelvis. My purpose is to empower women to live their best love lives.


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Kelly Casperson, MD | Board Certified Urologist · Sexuality & Hormones Expert and Advocate


Kelly Casperson, MD

She’s the sister, urologist, sex expert and friend you never knew you needed….until now.

Dr. Kelly Casperson is a board certified urologist. That makes her an expert of the pelvis. And her mission is to empower women to live their best love lives. Because let’s be honest. None of us were taught right. Combining the power of mind, body and relationships, Dr. Kelly joyously breaks down the societal barriers that are keeping us from awakening into our best intimate experience.

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