Investigation of Microbiomes of Postmenopausal Women Looking for Outcomes and Response to Estrogen Therapy

Inclusion Criteria: * Postmenopausal with vulvovaginal atrophy * Age ≥55 years old and a screening vaginal pH of ≥5. * Without menses for ≥12 months. * No uterovaginal or vaginal vault prolapse beyond the hymen. * No estrogen replacement within the last month (may come off current treatment, i.e. wash out, to join the study) Exclusion Criteria: * Patients with BMI \>35kg/m2 * Any patients with infections requiring antibiotic or antifungal therapy during the study period. * Study patients may not use any vaginal suppositories, douches, or vaginal hygiene wipes within the month preceding enrollment. For patients already on hormone therapy, will be allowed to undergo a "wash out" period of estrogen or progesterone products for one month prior to enrollment. * Additional exclusions included patients with systemic conditions requiring immunosuppressive drugs, currently receiving chemotherapy, or history of pelvic radiation. * Any patients with contraindications to vaginal estrogen therapy including: vaginal bleeding of unknown etiology; known, suspected, or history of breast cancer or estrogen-dependent neoplasia; active DVT, PE, or h/o these conditions; active arterial thromboembolic disease (ie. stroke or MI) or h/o of these; known liver disease or thrombophilic disorders. * Current tobacco use. * Allergy to Premarin® or its constituents. * Concurrent use of steroid creams for other indications (ie. lichen sclerosis)