I began using Premarin conjugated estrogen 0.625 in 2010. After a total hysterectomy I began developing tears in my vaginal walls, one large enough that I had to have my vaginal cuff resewn. I was put on Premarin and within months the problem disappeared. I was then told that due to my circumstances I was only to use the vaginal cream form because the oral form was not capable of doing " the job" I needed it to do, my doctor insisted that the creams remains localized therefore works better. Just this year I have began not being able to afford the $312.00 a month Rx because I have no insurance. I stopped using it in August and am finding myself " back in the same boat". Intercourse is painful, even with lubrication. I'm starting to have places that burn and sting ( inside the vagina) just like I did in 2010. My first question is -- once you've started using these products is there ever a point that your body just naturally takes over and starts maintaining the thickness of the vaginal walls or is it something you have to use forever? And my second question is do you know of any substitute that would be more affordable?