Topical estrogen cream or tablets
Generic estradiol 10-mcg insert vaginally daily x 2 weeks, then twice weekly indefinitely (lower cost option)
May take as long as 2-3 months to see maximal benefit
Warm patients about possible side effects of breast or perineal pain and uterine bleeding
Should not be used if history of cancer to reproductive organs or postmenopausal bleeding
Generic estradiol 10-mcg insert vaginally daily x 2 weeks, then twice weekly indefinitely (lower cost option)
May take as long as 2-3 months to see maximal benefit
Warm patients about possible side effects of breast or perineal pain and uterine bleeding
Should not be used if history of cancer to reproductive organs or postmenopausal bleeding
Atrophic vaginitis
Infection 
Bacterial vaginosis
Reaction to irritants 
Rhinorrhea
Vulvovaginal lichen planus
Contact vulvovaginitis
Vulvar lichen sclerosus