I am 33 years old and I had my right Ovary and Fallopian Tube removed at age 12. I had pretty regular periods for about 10 years after the surgery. In my early 20's, I was no longer having periods and was put on birth control pills so my body could get the hormones it needed. In my late 20's, I stopped taking the pills due to financial reasons. Last year when I went in to have my annual pap smear, I was having vaginal dryness and painful intercourse so the nurse practitioner suggested I start using Premarin cream. I used it for a few months and didnt notice much difference. This year I went to see a Urologist and explained that I haven't had a period for years and was not on any oral medicine and he was concerned. What are the long term effects on my body due to the lack of hormones? What are the risks of using hormone replacement for such an extended period? Is it better to use oral meds or vaginal cream? Can vaginal atrophy with very painful intercourse be alleviated with hormone replacement?