Systemic vs Vaginal Estrogen
Systemic estrogen addresses vasomotor, sleep, mood, bone, and cardiovascular symptoms. Vaginal estrogen addresses local genitourinary symptoms with minimal systemic absorption. They are often combined.
Systemic estrogen is the provider-reviewed pathway when vasomotor, sleep, mood, bone, or cardiovascular indications dominate.
Explore pathwayVaginal estrogen is the provider-reviewed pathway when genitourinary syndrome (vaginal dryness, dyspareunia, recurrent UTI) is the primary concern.
Explore pathwayEducational. Final pathway selection is provider-reviewed via synchronous video consultation against your biomarkers, history, and goals.
Frequently asked
Can I use both?
Yes — many candidates use systemic for whole-body symptoms and vaginal for local relief.
Does vaginal estrogen require progesterone?
Standard low-dose vaginal estrogen does not require systemic progesterone for endometrial protection.
Take the optimization assessment.
The adaptive assessment maps your symptoms, history, and goals to candidate pathways — and routes you into provider review.
Begin assessment