Abstract: Objective: This study was designed to evaluate the use of low dose vaginal estriol and low dose vaginal estradiol creams for the treatment of vulvovaginal atrophy. Methods: We designed a 12-week randomized double blinded pilot study. Participants applied the study cream daily (estriol 10mcg, estradiol 10mcg, or placebo) for 2 weeks and then twice weekly for a further 10 weeks. Results: Sixty three women were accrued, of whom 56 completed the study. There was no statistical difference between the three groups in improvement in the symptoms of vulvovaginal atrophy. There was a within group improvement for vaginal dryness and itch in all 3 arms. The within group improvement for vaginal dryness was greatest in the estriol group. Estriol levels remained <25ng/ml at baseline, week 2 and week 12 for all participants except 1 (in the placebo group at week 2 when it rose to 29.8ng/ml). Estradiol levels at week 2 in the estradiol group were significantly higher than week 2 levels in the estriol or placebo group. Conclusions: Low dose vaginal estriol cream is a feasible alternative to low dose vaginal estradiol cream for the treatment of vulvovaginal atrophy. Further research should include a larger volume of base cream and an adequately powered clinical trial.