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GLOW Below

GLOW Below

Skincare for Down There

The most effective female physician formulated solution that hydrates, rejuvenates, and repairs without a prescription.  The PH balanced formula provides both instant relief and long term benefits.  GLOW Below comes in your choice of bioidentical estrogen or bioidentical DHEA.  Each can be used alone or together for maximum results.

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Each bottle is a 3-month supply (only $33 per month!)

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Physician Formulated

Made in the U.S.A

Glow Below Vaginal Vitality Serum is the first-of-its-kind product specifically designed for the vaginal and vulvar tissues. This luxurious serum helps restore vaginal health and elasticity by providing moisture and suppleness where it’s needed most—deep inside your body!

GLOW Below contains clinically effective levels of low dose bioidentical Estrogen and DHEA that stays local to the vagina and do not raise blood or systemic levels. This makes it safe even for women who cannot use oral or systemic hormone replacement therapy.

GLOW Below with DHEA contains all the same ingredients and benefits as GLOW Below with Estrogen, except in an estrogen-free formulation.

  • Promotes vaginal tissue health and PH balance
  • Supports collagen production and elastin production
  • Immediate relief from itching, burning, dryness, and discomfort
  • Enhances natural lubrication and skin elasticity
  • Heightens sensitivity for greater sexual satisfaction
  • Increases comfort for pleasurable intercourse 
  • Reduces UTIs and yeast infections
  • Strengthens pelvic floor and reduces urinary incontinence 

GLOW Below was created with just a handful of the world's most effective and natural ingredients to nourish your private parts with everything they need, and nothing that they do not. Unlike most products on the market, GLOW Below is clean enough to eat

GLOW Below contains NO chemical, additives, fillers, GMO’s or preservatives. It is made with certified organic ingredients, is 100% plant based and cruelty-free. And because we believe in addressing the root cause, 

GLOW Below with Estrogen contains a clinically effective level of low dose bioidentical estriol and estradiol that stays local to the vagina and does not raise blood or systemic levels of estrogen. This makes it safe even for women who cannot use oral or systemic estrogen. And because the underlying cause behind all of these symptoms is estrogen deficiency, it works quickly and efficiently to provide long lasting relief and stronger, healthy cells and tissues. 

*GLOW Below with DHEA contains all the same ingredients and benefits as GLOW Below with Estrogen, except in an estrogen-free formulation.

We know your health is important to you. This is why we exceed industry standards across the board. Every ingredient is meticulously tested to ensure that all of our supplements are pure, potent, and effective.

  • Made in the USA: Glow Below is made in a state-of-the-art, FDA registered, Kosher Certitied, US facility with the highest standards in the industry. This allows for precise quality documentation throughout the entire manufacturing process. All finished products go through rigorous quality assurance testing that exceeds federal regulations.

  • Pharmaceutical Grade and Third-Party Tested: Every Ingredient is carefully sourced for maximum bioavailability . We’re also proud to be GMP/NSF Certified, as we’re dedicated to maintaining the highest industry standards for safety, purity, and quality.  Triple testing means that individual ingredients are tested for potency and purity first, then the final product blend is tested again, finally, third-party testing verifies, potency, purity, and efficacy. The bioidentical hormones in GLOW Below are USP verified for potency and purity.
  • Cruelty-Free and Free From Common Allergens: All of our products are cruelty-free, non-GMO, and NEVER tested on animals. GLOW Below is free from paraben, phthalates, BPAs and all endocrine disrupting compounds. We’re also allergen-free. No Gluten. No Corn. No Soy. No Dairy. No Crap!

GLOW Below with Estrogen:

  • Shea Butter
  • Sunflower Oil
  • Almond Oil
  • Micronized Estriol USP
  • Micronized Estradiol USP
  • Cocoa
  • Beeswax
  • Vitamin E
  • Hyaluronic Acid

GLOW Below with DHEA:

  • Shea Butter
  • Sunflower Oil
  • Almond Oil
  • USP DHEA (Dehydroepiandroserone)
  • Cocoa
  • Beeswax
  • Vitamin E
  • Hyaluronic Acid

GLOW Below can be used both internally and externally. Gently apply to your vulvar area, over your clitoris, all along the labia, over the urethra and the vaginal opening to the perineum. If desired, apply serum to clean finger and gently inset tip of finger into vaginal opening. Gently massage the serum into the labia minora and majora. This will allow the serum to get to all of the tissues that need the most nourishment. There is no need for an applicator as the ingredients in GLOW Below will make their way into the vaginal canal and the urethra as well as the entire vulvar area.

GLOW Below is PH balanced and designed for your delicate intimate area and anywhere on your body.

The Ultimate Daily Skincare Routine


Welcome To Your New Morning Ritual

Hydrate and repair delicate vaginal tissues with collagen and elastin building estrogen. Prevent urinary tract infections and urinary incontinence. Feel more comfortable and confident with this restorative age-rewinding serum


A Spicy Addition To Your Nightly Self Care

Vaginal DHEA acts on the nerves inside the vaginal wall to heighten sensations so you can actually enjoy intimacy. The hydrating and soothing properties also reduce pain and irritation.

Talking About This Issue Should Not Be Taboo

Women should not be surprised by changes the happen to their vagina, vulva and urinary tract as a resulting from the drop in the hormone, estrogen. which is a normal part of menopause and effects the vast majority of women.

However, most of us are confused, frustrated and frightened by the seemingly overnight changes to our vulvar and vaginal area. Now this is a simple, discreet solution to put an end to the pain and discomfort and allow you to regain your confidence and feminine power.

Vaginal Changes With Estrogen Loss

Dryness is a hallmark sign of menopause. As estrogen declines, the skin become thinner and more easily irritated, often becoming painful. Left untreated this condition known as Genitourinary Syndrome of Menopause (GSM) will continue to progress often leading to chronic urinary tract infections, urinary incontinence. and disruption to normal daily activity.

In addition to perimenopause and menopause, women who have been treated with chemotherapy, those with diabetes or circulatory issues and women who breastfeed for an extended period of time may also experience troubling vaginal symptoms regardless of their age.

Why Use Glow Below Vaginal Rejuvenation And Hydration Serum?

A vaginal vitality serum, like GLOW Below, can help to increase hydration around your vulva, vagina and surrounding areas to soothe and improve the skin tissue quality.

It will help with soothing any irritation or discomfort, protect and repair your skin barrier, and can even help with plumping and rejuvenate saggy or thin tissues.

Most importantly, GLOW Below can be used daily as part of your regular skincare routine and will help with overall vaginal health, vaginal ph, reducing UTI’s and overall comfort


90% of women see improvement in 2-4 weeks.

It might surprise you, but low-dose vaginal estrogen and DHEA are remarkably safe, highly effective and result in significant enhancements in quality of life. Within 1-4 weeks, around 90% of women experience positive changes.


Instantly rejuvenate, soothe, nourish and hydrate sensitive vaginal and vulvar tissues with a luxurious ph balanced formula.

Reverse atrophy and plushness of vaginal wall for greater comfort and pleasure during intercourse and all day confidence with continued use.

Replenish collagen and elastin as well as addressing the root cause of vaginal and vulva symptoms – the loss of the female hormone estrogen.

  • 01


    Shea Butter all-natural moisturizer that helps hydrate your skin from within. Shea butter contains vitamins A and E which are known to help promote healing while also providing soothing relief from vaginal dryness and irritation

  • 02


    Almond oil helps lock in moisture and provide lasting hydration. Almond oil has been shown to improve circulation in the pelvic region by increasing blood flow. This helps prevent cramping during menstruation and increases pleasure and lubrication during intercourse.

  • 03


    Hyaluronic acid is found naturally in the body and is responsible for keeping skin plump and smooth. It is a powerful humectant that penetrates deeply into the skin to protect against moisture loss and can help hydrate dry or aging vaginal skin cells. It also helps your vaginal tissues stay lubricated, which makes sex more comfortable and pleasurable.

  • 04


    Cocoa Butter is rich in antioxidants that help fight against free radicals and reduce the signs of aging. It also contains flavonoids, which are powerful anti-inflammatory agents that can help calm irritated skin. Cocoa also contains magnesium, which helps reduce inflammation and improve blood flow.

    Cocoa Butter has been used in Naturopathic Medicine to soothe sensitive tissues and the reverse atrophic vaginitis. Cocoa butter is rich with skin-loving fatty acids. It is often used to restore very dry, cracked skin and to replenish aging skin. It is deeply moisturizing, nourishing, and protective

  • 05


    This powerhouse ingredient provides antioxidant protection which helps protect your skin from free radicals that weaken the skin overtime and can lead to premature aging. It also aids in keeping your skin soft and supple while adding a little extra moisture to make sure everything stays moisturized and healthy. It helps repair the vaginal mucosa (the innermost layer of the vagina) and reduces dryness, itching, and burning.

    Vitamin E helps tighten, firm, and moisturize the skin. This ingredient has been clinically studied to help women improve vaginal hydration and comfort.

  • 06


    Low Dose Vaginal Estrogen can reduce or eliminate pain, discomfort, and Urinary Tract Infections (UTIs). Estrogen helps improve the body’s natural lubrication which can reduce pain during sexual intercourse. It also enhances the elasticity of tissue in the vagina walls which may help reduce the risk of UTIs. Lastly, estrogen promotes faster healing of tissues that may be damaged due to childbirth, age or hormonal changes, leading to more pleasurable sensations. Our estrogen-free formula contains DHEA which activates estrogen receptor sites and works similarly but with an estrogen-free formula.

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    In Less Than One Minute Per Day, You Can Experience....

    • Immediate soothing relief from itching, burning, dryness,and chafing
    • Enhanced natural lubrication Improved skin elasticity and restored tissue integrity
    • ​Increased blood flow and sensitivity for greater sexual satisfaction and improved
           vulvar health ​
    • More comfortable and pleasurable intercourse with greater stimulation and ability
          to orgasm
    • ​Reduced Urinary Tract Infections (UTI's) and yeast infection
    • ​Freedom from urinary incontinence and embarrassing leaks
    • ​Stronger pelvic floor ​
    • Restoration of natural vaginal texture, appearance and smell ​
    • Improved daily comfort and confidence

    More Pleasure Less Pain

    A vaginal moisturizer, like GLOW Below that contains low dose bioidentical estrogen or DHEA is an effective and natural way to help reduce discomfort and pain during sex. GLOW Below is specifically formulated to keep the vagina hydrated and healthy, which helps with lubrication, elasticity, and overall comfort. The low-dose estrogen stays local to the vaginal and vulvar region and helps to reverse any tissue damage caused by lack of hormones.

    Additionally, low dose estrogen and DHEA increase the sensitivity of the area, and improves blood flow, leading to more pleasurable sensations during intercourse. All in all, GLOW Below with Estrogen or GLOW Below with DHEA are both great choices for those dealing with discomfort or pain during sex due to hormonal insufficiency.

    Skin-care For Down There

    Protect your most delicate parts with GLOW Below, the skincare solution crafted for your intimate areas. Daily stressors like environmental pollutants, lifestyle habits, and harsh products can weaken the skin's natural defenses, causing premature aging and discomfort to your most sensitive tissues. Additionally, changes to hormone levels such as during perimenopause menopause, post-chemotherapy, postpartum can create dryness and irritation

    While we often focus on facial skincare, the intimate area also needs daily attention to maintain moisture, elasticity, Ph balance and optimal health. Rejuvenate, revitalize and restore with GLOW Below.

    Glow Up From The Waist Down

    You have the power to take charge of your intimate health and give your vagina the care it deserves. GLOW Below can help you “glow up” from the waist down, reverse discomfort and pain during sex, lower tissue damage, prevent UTI’s, candida, and leaks and increase sensitivity for more pleasurable sensations. GLOW Below provides immediate relief, but also helps you maintain healthy vaginal tissue over time which leads to more confidence in your body, improved quality of life and enhanced intimacy.

    Happiness Guaranteed!

    We are so confident that you will love the way Glow Below makes you feel that we are offering a completely risk-free full 90-day money back guarantee
    Try Glow Below


    Which should I choose? GLOW Below with Estrogen or GLOW Below with DHEA

    Both GLOW Below with Estrogen and GLOW Below with DHEA are great choices for any woman experiencing any of the symptoms of Genitourinary Syndrome of Menopause, including dryness, itching, burning, discomfort, pain with intercourse, chronic urinary tract infections, chronic yeast infections, loss of sensitivity, sexual dysfunction or incontinence.

    Both formulas are incredibly safe and do not increase blood levels of estrogen since they stay local to the tissues of the vulva, urethra and vagina. The main difference is that GLOW Below with Estrogen is slightly better and improving skin thickness, reversing atrophy and preventing urinary tract infections.

    GLOW Below with DHEA is slightly better at improving sexual function, sensitivity and sensation.

    The choice is yours and can be made based on what your most pressing issues are. The formulas can also be used in combination either by rotating days or using GLOW Below with Estrogen in the morning and GLOW Below with DHEA at night. Both products provide incredible relief across the board, however GLOW Below with Estrogen is a bit stronger in all areas except Sexual Pleasure where GLOW Below with DHEA is stronger.

    How much estrogen is in GLOW Below with Estrogen?

    GLOW Below with Estrogen contains a tiny dose of bioidentical estradiol and estriol, which is all that is needed to restore and revitalize the delicate vaginal and vulva tissues. The total estrogen in each pump of GLOW Below is 100 MCG in the form of 20 MCG Bioidentical Micronized Estradiol USP and 80 MCG Bioidentical Micronized Estriol USP. USP stands for United States Pharmacopia.

    How much DHEA is in GLOW Below with DHEA? Does GLOW Below with DHEA contain any estrogen

    GLOW Below with DHEA contains a small dose of bioidentical DHEA, which is all that is needed to restore and revitalize the delicate vaginal and vulva tissues. The total amount of DHEA in each pump of GLOW Below with DHEA is 5 mg of biodientical DHEA USP. USP stands for United States Pharmacopia.

    What is the suggested dosage of GLOW Below, how will I know how much to use?

    Please begin using 1 pump of GLOW Below daily.

    Some women will need less or more cream as time goes on. You want to use the smallest dose possible that provides relief, typically this is 1-2 pumps. After the first week, you can increase to 2 pumps if desired.

    Use GLOW Below for 60 days at the recommended dose (1-2 pumps daily) We expect you will see improvements in 6-8 weeks although many of our clients experience more immediate results. After 60 days, if you have not experienced any improvements, it is safe to increase your GLOW Below dose up to 4 pumps daily, 2 in the AM and 2 in the PM. For twice a day users, we suggest pairing GLOW Below with Estrogen with GLOW Below with DHEA for best result.

    After the initial 60 days of use, and once you’re experiencing improvements from daily use, you can go into a “maintenance” mode. Maintenance dosing is typically 5 times per week. You should continue at this maintenance dose. Note that if you discontinue use of the product you will return to your baseline.

    You may notice a warming and/or tingling sensation at first, which should not last longer than 10 to 15 minutes. This is more common in women who have a more severe degree of irritation and it is a sign that the product is working. This sensation will subside as the tissues continue to repair.

    If the warming and/or tingling sensation lasts for longer than 20 minutes, or creates a feeling of discomfort, discontinue use of GLOW Below for 72 hours. Then try using a 1 pump dose. If symptoms re-occur, consider alternating between GLOW Below and a natural moisturizer such as coconut oil or olive oil.

    How do I apply GLOW Below?

    You can safely apply GLOW Below with your clean fingers. Apply it to your vulvar area from your clitoris, all along the labia, over the urethra and the vaginal opening to the perineum. Gently massage the serum into the labia minora and majora. This will allow the serum to get to all of the tissues that need the most nourishment. There is no need for an applicator as the ingredients in GLOW Below will make their way into the vaginal canal and the urethra as well as the entire vulvar area.

    GLOW Below is PH balanced and designed for your delicate intimate area and anywhere on your body.

    GLOW Below is safe externally and internally, so women with more severe dryness may wish to insert GLOW Below into the vaginal opening using a clean fingertip. Wash your hands afterward. Glow Below can also be applied by pumping onto a tissue and wiping on.

    The serum will be well absorbed within 20 minutes.

    GLOW Below does contain hormones so please keep out of reach of children and pets and avoid sharing hand towels.

    Where EXACTLY do I put GLOW Below?

    Apply it to your vulvar area from mons pubis, over your clitoris, all along the labia, over the urethra and the vaginal opening to the perineum. Gently massage the serum into the labia minora and majora. This will allow the serum to get to all of the tissues that need the most nourishment. See diagram below to become more familiar with these terms and locations. There is no need for an applicator as the ingredients in GLOW Below will make their way into the vaginal canal and the urethra as well as the entire vulvar area.

    GLOW Below is PH balanced and designed for your delicate intimate area and anywhere on your body.

    Is this safe to use before intercourse, is it safe for my partner?

    Apply GLOW Below daily at any time of the day that works for you. Many women do well applying it first thing in the morning, after a shower, before or after a workout, before bed and before and after intercourse. Choose the time of day that works for you, it is safe to apply up to 4 pumps per day..

    Yes, GLOW Below can be applied before intercourse, and many women using GLOW Below prior to intercourse have found it to increase their ability to achieve orgasm. It is not harmful in any way to your partner. For women concerned about using GLOW Below with Estrogen, the estrogen is full absorbed within 20 minutes and will not transfer to your partner after that time. GLOW Below with DHEA can be used immediately before intercourse, in fact, you will be pleasantly surprised by the enhanced sexual sensations that GLOW Below with DHEA provides.

    Note: GLOW Below contains natural emollients, so please refer to your condom packaging to determine if it has any warnings relating to the use of oil-based products

    Is Vaginal Estrogen Safe?

    Yes. Low dose vaginal estrogen like in GLOW Below is extremely safe. There have been many studies since the WHI doing retrospective reviews for women only using low-dose vaginal estrogen products showing that there is no increased risk of cancer and cardiovascular events whatsoever. Vaginal estrogen even prevents urinary tract infections and morbidity associated with urinary tract infections, showing that it is actually more dangerous not to be using this medication in menopause. Individuals can use it safely for decades - essentially forever. You can start it when you’re 50 and take it until you’re 95 and you will only be healthier because of it.

    Low-dose vaginal estrogen, which is what is in GLOW Below, does not actually raise blood levels of estrogen. Therefore, it does not have any risks associated with traditional Hormone Replacement Therapy (HRT). Vaginal estrogen is a localized treatment, meaning it is only administered to the place it is aiming to treat and only has a localized effect on the vaginal tissues themselves. This is well-studied, widely documented, and supported by, the North American Menopause Society, and A4M. See references at the bottom of this page.

    What exactly is DHEA and Is Vaginal DHEA Safe?

    Dehydroepiandrosterone (DHEA) is a hormone that your body naturally produces in the adrenal gland. DHEA is a precursor to other hormones, including testosterone and estrogen. Vaginal DHEA can help to upregulate estrogen and provide many of the same benefits as vaginal estrogen. Is it very safe to use.

    According to the research of The North American Menopause Society (NAMS): Vaginal estrogen & DHEA treatment is 100% safe and effective in treating vaginal dryness, itching, burning, atrophy, painful sex and more. See references at the bottom of this page.

    Can I see the full ingredient list?

    GLOW Below contains only hand-picked active ingredients with no fillers or chemicals. GLOW Below is made with organic ingredients, is plant-based, paraben-free, cruelty-free, and allergen free. GLOW Below is made in the USA at a FDA registered, Kosher certified, GMP facility and is third party tested for purity.

    Here is the full ingredient list for each formula:

    GLOW Below with Estrogen:

    Shea Butter
    Sunflower Oil
    Almond Oil
    Micronized Estriol USP
    Micronized Estradiol USP
    Vitamin E
    Hyaluronic Acid

    GLOW Below with DHEA:

    Shea Butter
    Sunflower Oil
    Almond Oil
    UPS DHEA (Dehydroepiandroserone)
    Vitamin E
    Hyaluronic Acid

    Do you take insurance? How much does it cost?

    We are not in network with insurance providers. However, our prices are in many cases cheaper than your co-pay with insurance.

    Do you ship internationally?

    Yes, however, there will be an additional shipping fee calculated at checkout. Please contact for help placing international orders

    Do I need to test my hormone levels before using GLOW Below?

    No, not at all. GLOW Below is not intended to increase serum levels of Estradiol, Estriol or DHEA. Instead the low dose of estrogen and/or DHEA is absorbed locally into the vaginal and vulvar tissues.

    If you are interested in increasing your systemic levels of these hormones due to perimenopause or menopause I encourage you to check out my Healthy Hormone Club at Or watch my free hormone restoration masterclass at

    I am already taking bioidentical hormones...should I discontinue that while I'm using the GLOW Below serums??

    The Estradiol, Estrogen and DHEA in the GLOW Below serums are absorbed locally and should not affect circulating serum levels of your hormones and therefore will not impact your dose of your systemic hormone replacement. With that said, low-dose vaginal hormones are a great compliment to systemic hormone replacement.

    Where can I get more info on the vaginal changes that come with estrogen loss, Genitourinary Symptoms of Menopause (GSM) and treatment options?

    Dr. Michelle recorded a very informative video with a lengthy Q and A session at the end. The first 25 minutes gives you all the information that you need to know about vulva and vaginal atrophy and GSM, and then you can listen to the questions that other women had along with the answers.

    Collapsible content


    1. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. American family physician. 2000;61(10):3090–6. [PubMed] [Google Scholar]

    2. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. The journal of sexual medicine. 2009;6(8):2133–42. [PubMed] [Google Scholar]

    3. Nappi RE, Palacios S, Panay N, Particco M, Krychman ML. Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.. [Climacteric : the journal of the International Menopause Society Research Support, Non-U.S. Gov’t]. 2016;19(2):188–97. [PMC free article] [PubMed] [Google Scholar]

    4. Moral E, Delgado JL, Carmona F, et al. Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Climacteric : the journal of the International Menopause Society. 2018;21(2):167–73. [PubMed] [Google Scholar]

    5. Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. [Consensus Development Conference Research Support, Non-U.S. Gov’t]. 2014;79(3):349–54. [PubMed] [Google Scholar]

    6. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902; quiz 3–4. [PubMed] [Google Scholar]

    7. DiBonaventura M, Luo X, Moffatt M, Bushmakin AG, Kumar M, Bobula J. The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe. J Womens Health (Larchmt). [Comparative Study]. 2015;24(9):713–22. [PubMed] [Google Scholar]

    8. Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric : the journal of the International Menopause Society. [Review]. 2014;17(1):3–9. [PubMed] [Google Scholar]

    9. ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstetrics and gynecology. [Practice Guideline]. 2014;123(1):202–16. [PubMed] [Google Scholar]

    10. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728–53. [PubMed] [Google Scholar]

    11. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism. [Practice Guideline Research Support, Non-U.S. Gov’t]. 2015;100(11):3975–4011. [PubMed] [Google Scholar]

    12. Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstetrics and gynecology. [Review]. 2014;124(6):1147–56. [PMC free article] [PubMed] [Google Scholar]

    13. Cardozo L, Bachmann G, McClish D, Fonda D, Birgerson L. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstetrics and gynecology. [Meta-Analysis Research Support, Non-U.S. Gov’t]. 1998;92(4 Pt 2):722–7. [PubMed] [Google Scholar]

    14. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. The Cochrane database of systematic reviews. [Meta-Analysis Research Support, Non-U.S. Gov’t Review]. 2016(8):CD001500. [Google Scholar]

    15. Mitchell CM, Reed SD, Diem S, et al. Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms: A Randomized Clinical Trial. JAMA internal medicine. 2018;178(5):681–90. [PMC free article] [PubMed] [Google Scholar]

    16. Pinkerton JV, Kaunitz AM, Manson JE. Not time to abandon use of local vaginal hormone therapies. Menopause. 2018;25(8):855–8. [PubMed] [Google Scholar]

    17. Kingsberg SA, Krychman M, Graham S, Bernick B, Mirkin S. The Women’s EMPOWER Survey: Identifying Women’s Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. The journal of sexual medicine. 2017;14(3):413–24. [PubMed] [Google Scholar]

    18. Manson JE, Goldstein SR, Kagan R, et al. Why the product labeling for low-dose vaginal estrogen should be changed. Menopause. [Editorial]. 2014;21(9):911–6. [PubMed] [Google Scholar]

    19. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. Jama. [Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, U.S. Gov’t, P.H.S.]. 2002;288(3):321–33. [PubMed] [Google Scholar]

    20. Archer DF . Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause. [Research Support, Non-U.S. Gov’t Review]. 2010;17(1):194–203. [PubMed] [Google Scholar]

    21. Vulvar Lev-Sagie A. and Vaginal Atrophy: Physiology, Clinical Presentation, and Treatment Considerations. Clinical obstetrics and gynecology. [Review]. 2015;58(3):476–91. [PubMed] [Google Scholar]

    22. Naessen T, Rodriguez-Macias K. Endometrial thickness and uterine diameter not affected by ultralow doses of 17beta-estradiol in elderly women. American journal of obstetrics and gynecology. [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2002;186(5):944–7. [PubMed] [Google Scholar]

    23. Weisberg E, Ayton R, Darling G, et al. Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet. Climacteric : the journal of the International Menopause Society. [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2005;8(1):83–92. [PubMed] [Google Scholar]

    24. Dorr MB, Nelson AL, Mayer PR, et al. Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis. Fertility and sterility. [Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2010;94(6):2365–8. [PubMed] [Google Scholar]

    25. Eugster-Hausmann M, Waitzinger J, Lehnick D. Minimized estradiol absorption with ultra-low-dose 10 microg 17beta-estradiol vaginal tablets. Climacteric : the journal of the International Menopause Society. [Randomized Controlled Trial]. 2010;13(3):219–27. [PubMed] [Google Scholar]

    26. Santen RJ, Pinkerton JV, Conaway M, et al. Treatment of urogenital atrophy with low-dose estradiol: preliminary results. Menopause. [Clinical Trial]. 2002;9(3):179–87. [PubMed] [Google Scholar]

    27. Crandall CJ, Hovey KM, Andrews CA, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018;25(1):11–20. [PMC free article] [PubMed] [Google Scholar]

    28. Morch LS, Kjaer SK, Keiding N, Lokkegaard E, Lidegaard O. The influence of hormone therapies on type I and II endometrial cancer: A nationwide cohort study. International journal of cancer. [Research Support, Non-U.S. Gov’t]. 2016;138(6):1506–15. [PubMed] [Google Scholar]

    29. Lokkegaard E, Nielsen LH, Keiding N. Risk of Stroke With Various Types of Menopausal Hormone Therapies: A National Cohort Study. Stroke. 2017;48(8):2266–9. [PubMed] [Google Scholar]

    30. Carrasquilla GD, Frumento P, Berglund A, et al. Postmenopausal hormone therapy and risk of stroke: A pooled analysis of data from population-based cohort studies. PLoS medicine. [Observational Study]. 2017;14(11):e1002445. [PMC free article] [PubMed] [Google Scholar]

    31. Belanger C, Speizer FE, Hennekens CH, Rosner B, Willett W, Bain C. The nurses’ health study: current findings. The American journal of nursing. [Research Support, U.S. Gov’t, P.H.S.]. 1980;80(7):1333. [PubMed] [Google Scholar]

    32. Belanger CF, Hennekens CH, Rosner B, Speizer FE. The nurses’ health study. The American journal of nursing. 1978;78(6):1039–40. [PubMed] [Google Scholar]

    33. Colditz GA, Manson JE, Hankinson SE. The Nurses’ Health Study: 20-year contribution to the understanding of health among women. Journal of women’s health / the official publication of the Society for the Advancement of Women’s Health Research. [Research Support, U.S. Gov’t, P.H.S.]. 1997;6(1):49–62. [Google Scholar]

    34. Bao Y, Bertoia ML, Lenart EB, et al. Origin, Methods, and Evolution of the Three Nurses’ Health Studies. American journal of public health. 2016;106(9):1573–81. [PMC free article] [PubMed] [Google Scholar]

    35. World Health Organization; IHD Registers: Report of the Fifth Working Group. . In: Organization WH, editor. Copenhagen; 1971. [Google Scholar]

    36. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined–a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Journal of the American College of Cardiology. [Guideline Practice Guideline]. 2000;36(3):959–69. [PubMed] [Google Scholar]

    37. Walker AE, Robins M, Weinfeld FD. The National Survey of Stroke. Clinical findings. Stroke. [Research Support, U.S. Gov’t, P.H.S.]. 1981;12(2 Pt 2 Suppl 1):I13–44. [PubMed] [Google Scholar]

    38. Pun VC, Hart JE, Kabrhel C, Camargo CA Jr., Baccarelli AA, Laden F Prospective Study of Ambient Particulate Matter Exposure and Risk of Pulmonary Embolism in the Nurses’ Health Study Cohort. Environmental health perspectives. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t]. 2015;123(12):1265–70. [PMC free article] [PubMed] [Google Scholar]

    39. Kabrhel C, Varraso R, Goldhaber SZ, Rimm E, Camargo CA, Jr. Physical inactivity and idiopathic pulmonary embolism in women: prospective study. BMJ. [Research Support, N.I.H., Extramural]. 2011;343:d3867. [PMC free article] [PubMed] [Google Scholar]

    40. Poole EM, Lin WT, Kvaskoff M, De Vivo I, Terry KL, Missmer SA. Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of U.S. nurses. Cancer causes & control : CCC. 2017;28(5):437–45. [PMC free article] [PubMed] [Google Scholar]

    41. Puckett CD. The Educational Annotation of ICD-9-CM; Diseases and Procedures Tabular Lists. Reno, NV; 1986. [Google Scholar]

    42. Rich-Edwards JW, Corsano KA, Stampfer MJ. Test of the National Death Index and Equifax Nationwide Death Search. American journal of epidemiology. [Research Support, U.S. Gov’t, P.H.S.]. 1994;140(11):1016–9. [PubMed] [Google Scholar]

    43. Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. American journal of epidemiology. [Research Support, U.S. Gov’t, P.H.S.]. 1984;119(5):837–9. [PubMed] [Google Scholar]

    44. Zahl PH, Jorgensen KJ, Maehlen J, Gotzsche PC. Biases in estimates of overdetection due to mammography screening. The Lancet Oncology. [Comment Letter]. 2008;9(3):199–201; author reply −2. [PubMed] [Google Scholar]

    45. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. Jama. [Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Intramural]. 2013;310(13):1353–68. [PMC free article] [PubMed] [Google Scholar]

    46. Lyytinen H, Pukkala E, Ylikorkala O. Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstetrics and gynecology. [Research Support, Non-U.S. Gov’t]. 2006;108(6):1354–60. [PubMed] [Google Scholar]

    47. Pinkerton JV, Kaunitz AM, Manson JE. Vaginal estrogen in the treatment of genitourinary syndrome of menopause and risk of endometrial cancer: an assessment of recent studies provides reassurance. Menopause. 2017;24(12):1329–32. [PubMed] [Google Scholar]

    48. Labrie F, Cusan L, Gomez JL, et al. Effect of one-week treatment with vaginal estrogen preparations on serum estrogen levels in postmenopausal women. Menopause. [Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2009;16(1):30–6. [PubMed] [Google Scholar]

    49. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. The Cochrane database of systematic reviews. [Meta-Analysis Review] 2006(4):CD001500. [PubMed] [Google Scholar]

    50. Michaelsson K, Baron JA, Farahmand BY, Ljunghall S. Use of low potency estrogens does not reduce the risk of hip fracture. Bone. [Research Support, Non-U.S. Gov’t]. 2002;30(4):613–8. [PubMed] [Google Scholar]

    51. Naessen T, Berglund L, Ulmsten U. Bone loss in elderly women prevented by ultralow doses of parenteral 17beta-estradiol. American journal of obstetrics and gynecology. [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 1997;177(1):115–9. [PubMed] [Google Scholar]