Objective: Local estrogens are used for the treatment of genitourinary symptoms of menopause. The efficacy and adverse effects of both estrogen-containing vaginal tablets (VT) and estrogen-containing vaginal creams (VC)/gels are comparable. Our objective was to assess the compliance and adherence to treatment in a large population. Methods: A retrospective study on women aged 40 to 89 was performed in the Central District of the "Clalit" Health Services between 2006 and 2014. Demographic data on all women and usage details were electronically recorded. Patients eligible for analysis used VT or VC for at least 4 consecutive months. Results: A total of 2,269 patients used continuous monotherapy, of them 1,782 patients received treatment only with VC and 487 received treatment only with VT. Sixty-four percent of women treated with VT were treated for at least 4 months compared with 39% of women administered with VC (P < 0.000006). After 6 months of treatment, 83% of women with VT were asked for another prescription compared with 54% of women with VC (P < 0.001). The mean duration of treatment was 1,002 +/- 38 days for the VT-treated women, and 787 +/- 25 days for the VC-treated group (P < 0.000006). Conclusions: The present study showed superiority in the compliance and adherence of postmenopausal women to treatment with estrogen tablets over estrogen gel.