The Vaginal Estrogen Data Behind the Data: What 766 Women Are Telling Us About the Real Gaps in Menopause Care

We Have a Recognition Problem, Not a Treatment Problem

In the free article, I shared the headline finding from our survey: among women using hormone therapy, a surprisingly large proportion are also using vaginal estrogen. But the deeper story is not simply that women are using two forms of estrogen. The deeper story is that many women appear to arrive at vaginal estrogen late, after persistent symptoms, incomplete counseling, unclear dosing instructions, cost barriers, and months or years of trying to solve genitourinary symptoms on their own.

Our survey, Menopause in 2026: Your Voice Can Advance Science, included 766 consenting respondents. Among hormone-therapy-experienced respondents, 86.1% reported systemic estrogen exposure and 61.5% reported vaginal estrogen exposure. Because the survey allowed multi-select answers but did not provide respondent-level cross-tabulation for this specific question, the exact overlap cannot be directly calculated. Epidemiologically, we can bound it. At minimum, 47.6% of HT-experienced women used both systemic and vaginal estrogen. At maximum, 61.5% did. The most plausible estimate is around 55%.

That means roughly one in two women in this hormone therapy cohort is using both routes of estrogen, and that number deserves more attention than it usually gets.