Sustainability of Vaginal Estrogen Therapy in Postmenopausal Women

Inclusion Criteria: * Postmenopausal women (last menstrual period more than 12 months ago or having undergone bilateral ovariectomy) * Age ≥ 18 years * Diagnosis of moderate to severe vaginal atrophy at screening visit with VMI \< 50% and vaginal pH \> 4.5 * At least one subjective symptom of vaginal atrophy (dryness, pain/burning sensation, pruritus, discharge, dyspareunia) related to a score of ≥ 65 on the visual analogue scale (VAS) * Indication for vaginal treatment with Gynoflor® (100 million viable L. acidophilus KS 400 and estriol 30 mcg per application) for 6 weeks because of symptomatic vaginal atrophy after menopause: 1 vaginal tablet daily for 12 days, followed by 3 vaginal tablets per week as maintenance therapy (Monday-Wednesday-Friday). * Informed consent as documented by signature Exclusion Criteria: * Administration of any form of oral/transdermal hormone therapy (HT) or selective estrogen receptor modulators (SERM) or phytoestrogens within 2 months prior to entry into or during the study. * Any use of over-the-counter vaginal products within 1 week prior to and during entry the study. * Known hypersensitivity or allergy to the investigational product * Estrogen dependent malignancy * Undiagnosed genital bleeding * Active thromboembolism * Active vulvovaginal Candidiasis, Trichomonas vaginitis or bacterial vaginitis based on light microscopy of vaginal secretions, vaginal pH, whiff test and KOH preparation * Active sexually transmitted infections (STI) including herpes simplex viral infection, gonorrhoea and Chlamydia. * Active urinary tract infection. * Pessary-users * Immunocompromised patients including those with human immunodeficiency viral infection, chronic glucocorticoid use or active treatment with immunosuppressive agents * Severe liver and/or kidney disease * Diabetes mellitus * Polyneuropathy * Skin disease affecting vulva or vagina, e.g. lichen sclerosus * Known or suspected non-compliance, drug or alcohol abuse * Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant, * Participation in another study with investigational drug within the 30 days preceding and during the present study.