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In a recent comparison of estradiol and conjugated estrogen creams,6 single intravaginal doses of both estrogens were well absorbed by postmenopausal women. Only the estradiol cream led to plasma estrone and estradiol levels of premenopausal women. Symptoms of menopause have largely been attributed to a decrease in estrogen secretion, a normal process of aging. While the question of the best mode of therapy is controversial, physiological replacement would be a logical choice for postmenopausal vasomotor symptoms and vaginal mucosa atrophy. Our study was conducted to determine estrogen levels achieved after nightly vaginal administration of estradiol cream for 14 days and to evaluate it in the treatment of postmenopausal signs and symptoms. Materials and methodsThe patients were postmenopausal for at least 1 yr and had vasomotor or vaginal symptoms of estrogen deficiency. They received no estrogen or medications which could interfere with estrogen assays for at least 1 mo prior to the study. The study followed a double-blind parallel design. On a random assignment 20 patients received estradiol vaginal cream 0.01% (0.2 mg 17,8-estradiol) and 10 patients received conjugated estrogen cream (1.25 mg conjugated estrogens). An intravaginal dose of 2 gm of cream was administered at bedtime for 14 consecutive days. Patients returned for evaluation of their therapy on day 8 (12 hr after their seventh dose) and day 15 (12 hr after their fourteenth dose).Efficacy of the creams was measured by the maturation indices of the vaginal epithelium cells and severity ratings of vaginal and vasomotor symptoms at each visit. Patients were asked to record the number of vasomotor symptoms per day, and the severity of the hot flashes, 502

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