The natural drop in estrogen causes the vagina to become drier and the tissues to become thinner, a situation that can cause pain during penetration. Using lubricants can help, but estrogen helps some women more.
The consensus is, however, that formulations that deliver the hormones directly to the vulva or vagina are safer. Local estrogen treatment wont help with hot flashes and other menopause symptoms, but "you can achieve vaginal health without using systemic estrogen," says Irwin Goldstein, MD (no relation to Andrew), director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine. If this treatment does begin to affect menopausal symptoms, Dr. Goldstein suggests checking in with your doctor, because the estrogen may be entering your bloodstream.