Vaginal and Urinary Microbiome Trial

Inclusion Criteria: * Age 18-years old * Women who qualify for vaginal estrogen * Suitability for follow-up * Hormonally post-menopausal status: Bilateral past ovarian removal, ≥1 year since last menses if uterus in place, OR hysterectomized woman with ≥1 ovary in place AND \>1 year of menopausal symptoms or laboratory confirmation of menopausal hormonal status (such as serum follicle stimulation hormone \>25 IU/mL) * GSM symptoms (including, but not limited to genital symptoms of dryness, burning, itching, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired sexual function; and urinary symptoms of urgency, frequency, dysuria and recurrent (UTIs) Exclusion Criteria: * Age \< 18-years old * Known allergic reaction or other adverse reactions to Premarin® or any of its components or apricot kernel oil * Nut allergy * Inability to use or place vaginal therapy due to altered mental status or anatomical reasons * Already using vaginal estrogen or apricot kernel oil in the past two weeks * Known active vaginal infection (symptomatic and/or untreated) or completion of treatment for bacterial vaginosis or cervical/vaginal infection within one week of recruitment * History of recurrent or chronic bacterial vaginosis with \> 2 episodes per year or symptoms reported for \> 6 months out of the last year. * History of active vaginal ulcerative disease (active ulcers from atrophy, herpes symptoms at recruitment or herpes with \>2 outbreaks per year or…