There are two. Systemic therapy, which reaches the whole body as a patch, gel, spray, tablet or ring, treats hot flashes, night sweats, sleep and bone loss. Low-dose vaginal estrogen, as a cream, tablet or ring, treats dryness and urinary symptoms only, with very little absorbed elsewhere. Many women use both.
The first decision
Los Angeles treatment options: whole body, or just where it hurts
The first fork in Los Angeles treatment is whether the problem is everywhere or in one place, because systemic estrogen and local estrogen answer different questions. Systemic estrogen circulates and treats the symptoms driven by falling hormone levels everywhere: flashes, night sweats, broken sleep, mood, joint aches and bone density.
Low-dose vaginal estrogen does one job very well. It restores the tissue in and around the vagina and urethra, and clears dryness, irritation and recurrent urinary symptoms in the large majority of women who use it. Almost none of it reaches the bloodstream.
They are not alternatives. A woman treating hot flashes with a patch may still need a vaginal preparation, because a systemic dose does not always reach that tissue adequately. Worth reading next: vaginal dryness, vaginal estrogen and hormone pellets go further into it. Tell us which complaint bothers you most and which you could live with, because in Los Angeles that ranking shapes what gets prescribed first.
