Difference in Serum Estrogen Level Based on Methods of Vaginal Estrogen Application (fingertip Vs Applicator Use) in Post-menopausal Women

Inclusion Criteria: * patients who are postmenopausal for at least 1 year (since their last menses) * patients who qualify for treatment with vaginal estrogen cream and are willing to complete the treatment * English speaking patients * patients should be able to self-apply the vaginal estrogen cream using the applicator method and the fingertip application * Patients who are surgically menopausal * Military healthcare beneficiary status Exclusion Criteria: * pre and perimenopausal women * contraindication to estrogen therapy (Deep vein thrombosis, history or active cancer) * women who are not able to self apply the vaginal estrogen cream * vaginal bleeding of unknown origin * women currently on hormone replacement therapy or vaginal estrogen therapy