The newest dosing for estradiol (Vagifem) is 10 μg, and the 25 μg is being phased out – the higher dose will only be available until supplies are depleted (“Tissue changes associated with vaginal atrophy,” September 2010). I also use lower-than-recommended doses of vaginal estrogen cream, and patients do well with fewer complaints of excessive mess. Compounding pharmacists can design customized vaginal suppositories that may be more cost-effective, depending on dose and pharmacy location. — RAMONA G. SCOTT, WHNP, Knoxville, Tenn.

The data support use of the lower estradiol doses in the treatment of vaginal atrophy. As with all medications, it is best to use the lowest effective dose, and Vagifem 10 μg is very effective. I have not used the lower-than-recommended doses of vaginal cream but again, if this approach controls the patient’s symptoms, it should be considered effective based on a case-by-case response. — Sarah B. Freeman, PhD, ARNP, FAANP (145-18)