In this review, Santen identified articles that assessed the use of vaginal estrogen as a local therapeutic method to manage symptoms resulting from vulvovaginal atrophy, without increasing plasma estradiol levels. Overall, low-dose vaginal estrogen was found to be effective at increasing plasma estradiol levels during chronic administration but not above the normal range. Vaginal estrogen was also associated with systemic effects to lower plasma levels of low density lipoprotein (LDL) cholesterol and bone resorption rates.
