Is vaginal estrogen cream safer than estrogen pills?

Vaginal estrogen, delivered as a cream or tablet or flexible plastic ring, is used to treat vaginal dryness. This was officially called vaginal atrophy but I never liked to use that term with my patients! The new term is Genitourinary Syndrome of Menopause, or GSM. Vaginal estrogen is a local treatment with minimal absorption into the blood stream so also minimal to no effect on other parts of the body. While we need more studies, all the evidence to date indicates that this local treatment does not increase the risk of complications seen in estrogen or estrogen plus progesterone systemic therapies.