Intervention: Estradiol
Trial phase: Phase 4
ATC code: G02BB01 | G03AA14 | G03AA17 | G03AB08 | G03CA03 | G03CA53 | G03EA01 | G03EA02 | G03EA03 | G03FA01 | G03FA02 | G03FA03 | G03FA04 | G03FA05 | G03FA06 | G03FA07 | G03FA08 | G03FA09 | G03FA10 | G03FA11 | G03FA12 | G03FA13 | G03FA14 | G03FA15 | G03FA16 | G03FA17 | G03FB01 | G03FB02 | G03FB03 | G03FB04 | G03FB05 | G03FB06 | G03FB07 | G03FB08 | G03FB09 | G03FB10 | G03FB11 | G03FB12 | G03HB01 | H01CC53 | H01CC54
SMILES: [H][C@@]12CCc3cc(O)ccc3[C@@]1([H])CC[C@]1(C)[C@@H](O)CC[C@@]21[H]
Sex: Female
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 35
Group description: The intervention for this study is an estrogen cream (i.e., Premarin Cream®). Women in this study will receive this estrogen cream and apply it to their vagina twice weekly for 12 weeks

Estrogen Cream: Participants are provided a vaginal estrogen cream (i.e., Premarin Cream® 0.625 mg conjugated estrogen/gram) and instructed to use 0.5 grams with an applicator twice weekly for 12 weeks.
Eligibility criteria:
Inclusion Criteria:

Women who present with symptoms of OAB, defined as a condition characterized by urgency, with or without urgency incontinence, usually with frequency and nocturia in the absence of obvious pathology or infection [9], with atrophic vaginitis.
Postmenopausal by history (i.e., defined as twelve months or greater since last menstrual period), surgical menopause with removal of bilateral ovaries, or age over 55 with a previous hysterectomy (without removal of bilateral ovaries).
English language skills sufficient to complete questionnaires
Clinical indication for vaginal estrogen use (i.e., hypoestrogenic findings on physical examination)
Patients not currently receiving vaginal estrogen therapy

Exclusion Criteria:

Patients currently on systemic hormone replacement therapy (HRT) or who have been on HRT within the past three months
Patients with current diagnosis or history of estrogen dependent malignancies (e.g., breast or endometrial malignancies)
Contraindication or allergy to estrogen therapy
Insufficient English language skills to complete study questionnaires
Women with active, standard culture positive urinary tract infection at baseline assessment, or those with a urine dip positive for leukocytes and nitrates on straight catheterized sample.
Patients who have received antibiotics within the past two weeks
Patients with stage 3 or 4 pelvic organ prolapse based on the pelvic organ prolapse quantitation system (POP-q)
Patients unwilling to use vaginal estrogen preparation
Patients currently on anticholinergic medications or who have received anticholinergic medications within the past three months
Patients who have previously failed two medications for treatment of OAB or have previously received more advanced treatment for OAB including intra-vesicle botulinum toxin injections, posterior tibial nerve stimulation, or implantation of a sacral neuromodulator
Patients wishing to start anticholinergic medication at the initial encounter
Undiagnosed abnormal genital bleeding
Active deep vein thrombosis (DVT), pulmonary embolism (PE), or a history of these conditions
Active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions
Known liver dysfunction or disease
Known protein C, protein S, or antithrombin deficiency or other known thrombophilic disorders