NCT02869165 - 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 last outbreak <1month ago, or vaginal laceration. - Chronic antibiotic or probiotic use for indications not listed. - Pelvic organ prolapse beyond the hymenal ring - Using a vaginal pessary or indwelling urinary catheter - Evidence of active urinary tract infection by history and symptoms, urine dipstick, or urine culture on day of presentation or within last 2 weeks (defined as ≥ 100,000 colonies same pathologic bacteria on clean catch or 10,000 colonies on straight catheter specimen) - Recurrent urinary tract infection 3 episodes with the last year or 2 episodes within the last 6 months. - History of venous or arterial thromboembolism or genetic predisposition to thromboembolism. - Ovarian cancer and estrogen responsive cancer including endometrial or breast or breast cancer history of unknown hormonal status - Vaginal mesh erosion, sutures visible in the vagina or granulation tissue - Uncorrected vesicovaginal or rectovaginal fistula - Severe fecal or anal incontinence - Active vulvar dermatoses (lichen sclerosis, Behcet's disease, vulvar eczema) and on chronic topical steroids. - Subjects with absolute contraindications to estrogen, such as diabetes mellitus with end-organ damage and vascular disease, impaired liver function or a hepatic hemangioma, chronic renal disease, migraine with aura, systemic lupus erythematosus with prior thrombosis or vascular damage or other end-organ damage - Patients < 6 weeks postop - Inability to speak or read English