What changes should I expect? For many women, so can the regular use of long-acting vaginal moisturizers when combined with regular vaginal sexual activity. My husband and I are in our late 60s. Is this abnormal? Should I be? Although higher doses of estrogen the doses needed to treat hot flashes are associated with risks, including heart disease in older women and breast cancer, the very low doses of estrogen needed to treat vaginal dryness—and which are applied directly in the vagina—are considered safe. Blood levels of estrogen in women who use only low doses of vaginal estrogen are minimally elevated compared with women not using any estrogen, and are still within the normal range for women at menopause and afterward. Could the hot flashes be affecting my libido? Although hormone therapy with estrogen or with estrogen plus progestogen is associated with risks, if the hot flashes are disruptive and other measures are not helpful, the benefits of hormone therapy often outweigh the risks for healthy women in early menopause.
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