Abstract: The present invention relates to methods for the prevention and treatment of conditions arising from local estrogen deficiency, such as dyspareunia, vulvar atrophy, vaginal atrophy, vaginal dryness, vulvar itching, vaginal itching, vulvar burning, vaginal burning, vulvar dystrophy, atrophic vaginitis or menopausal sexual dysfunction. In some embodiments, the methods include systemic, for example oral, administration of an estrogen, such as conjugated estrogens, and a progestagen, such as MPA, contemporaneously with local administration of an estrogen, for example conjugated estrogens. In some embodiments, the methods include the oral administration of conjugated estrogens and MPA, and the vulvar, vaginal, or vulvar and vaginal administration of conjugated estrogens, for example in a cream.