I was perimenopausal in my late 30's. I started experiencing painful intercourse. I was not able to use available hormonal meds such as Premarin (pill or cream), because I'd had blood clots in both lungs from birth control pills in my 20's. This was in 1974. I cannot imagine how awful my life would have been these past 30 years (I'm 70) were it not for my prescriber and the compounding pharmacists. The form of estrogen in the cream is of a type that stays in the vaginal tissues and vastly decreases pain during intercourse. I cannot take anything that could enter my bloodstream; otherwise, I could develop clots again.