@bmalsch

I looked this up because it is new for me. While reading about it I began to wonder if you had explored bhrt with your health provider. Can you share a bit of information about yourself. Age, when you entered menopause, Osteoporosis, vaginal atrophy and dryness?

@bmalsch
Osphena seems to be a pill based replacement for estrogen in the vaginal area, but with greater side effects than estrogen, especially estriol vaginally. Many women do not like the vaginal creams so osphena was developed for that group of women.

Osphena is generally not considered safer than vaginal estriol (or estradiol) and it is more costly than those treatments. Indeed, Osphena is an oral pill that travels through the entire body (systemic), whereas vaginal estriol/estradiol stays largely within the vaginal area. This means that osphena is subject to the first pass problems in the liver and also the systemic impact on the whole body. Whereas, vaginal creams do not pass thru the liver and they are less likely to impact other portions of the body like the breast.

Ai overview of the available literature and research:
Osphena (ospemifene) is an oral, non-hormonal (SERM) tablet for moderate-to-severe vaginal atrophy, offering similar efficacy to local estrogen with risks of hot flashes, blood clots, and endometrial stimulation. It is generally not considered safer than low-dose vaginal estriol, which has minimal systemic absorption, but it provides a convenient, non-messy, pill-based alternative for those avoiding creams