How do you counsel patients on how to use vaginal estrogen?

Vaginal estrogen comes in multiple formulations: creams, tablets, suppositories, and rings. Because vaginal estrogen does not become systemic, there is no need to add progesterone for uterine protection when using vaginal estrogen. Likewise, there is no concern for systemic effects of estrogen when using vaginal estrogen, making it usable for nearly all postmenopausal women, even those with contraindications to menopausal hormone therapy (e.g., high ASCVD risk, h/o VTE; caution with women with estrogen-dependent tumors).

Tablets and suppositories are inserted (either self-inserted or via an applicator) daily for 2 weeks, then twice a week thereafter. The vaginal ring, Estring, is inserted every 3 months (not to be confused with Femring, whi...