Genital atrophy, if present, can be treated with topical estrogen such as the following: 0.01% estradiol vaginal cream 2 to 4 g (once a day for 1 to 2 weeks), followed by 1 to 2 g (once a day for 1 to 2 weeks), then 1 g (1 to 3 times weekly) Estradiol vaginal tablets 4 or 10 mcg twice a week Estradiol ring (releases approximately 7.5 mcg / d) every 3 months Topical estrogen therapy is usually preferred for genitourinary syndrome of menopause, because it is more effective for this indication and has lower risk of adverse effects than systemic menopausal hormone therapy.