The Vaginal Health Trial

Inclusion Criteria * Females aged 45-70 years * 2 or more years since last natural menstrual period, or surgical menopause (bilateral oophorectomy) * At least 1 vaginal symptom (inside or outside the vagina) reported from the following list, experienced in the past 30 days which is moderate or severe: * Dryness at least once a week * Itching at least once a week * Irritation at least once a week * Soreness/Pain at least once a week * Pain associated with sexual activity at least once * Signed informed consent Exclusion Criteria * Current unexplained abnormal genital bleeding (or any unevaluated bleeding since menopause) * Currently pregnant, attempting pregnancy or breast feeding * Current acute vaginal infection (as indicated by wet mount at V1) * Pelvic or vaginal surgery in prior 60 days * Antibiotic use in the past 30 days * Women under age 55 with endometrial ablation * Women under age 55 with hysterectomy and at least one ovary * Current cancer treatment (exception basal or squamous skin cell cancers) * Current or past thromboembolic disease (pulmonary embolus or deep vein thrombosis, not including thrombophlebitis), myocardial infarction or stroke * Current severe liver disease * Current or past breast or endometrial cancer or pre-cancer * Blood clotting disorder (e.g., Factor V Leiden, prothrombin mutation, protein C, protein or antithrombin deficiency) * Porphyria * Current or past lichen sclerosus or lichen planus * History of adverse reaction to vaginal estrogen or Replens * Use of any systemic reproductive hormones (hormonal contraception, postmenopausal hormone therapies, SERMS) in the past 2 months * Use of hormonal contraception in the past year * Use of any type of vaginal estrogen product (however interested women will be allowed to join the study if they abstain from use during the month preceding enrollment) * Use of any type of vaginal moisturizer, douche, vaginal prebiotic or probiotic, or soap in the vagina in the past month (however interested women will be allowed to join the study if they abstain from use during the month preceding enrollment) * Unwilling to abstain from use of any non-study vaginal moisturizer, vaginal estrogen, douche, or soap in the vagina throughout the trial * Unable to follow instructions, complete questionnaires, or physically unable to place product in the vagina * Current participation in another drug trial or intervention study * Chronic vulvo-vaginal symptoms in the 5 years before menopause (defined as a vaginal or vulvar condition requiring more than 4 visits to a health care provider in a given year)