The effects of local 17beta-oestradiol therapy on the vaginal mucosa and endometrial thickness were studied in 35 post-menopausal women with symptoms of vaginal atrophy. Signs and symptoms of vaginal atrophy were measured by anamnesis, visual examination and the maturation index before and after 12 weeks' treatment with 17beta-oestradiol in the form of vaginal tablets. The maturation proportion on vaginal smear, endometrial thickness on transvaginal ultrasonography and plasma concentrations of follicle-stimulating hormone, luteinizing hormone and oestradiol were also determined. All vaginal atrophy signs and symptoms significantly improved and there was a significant increase in vaginal smear maturation with 17beta-oestradiol treatment. Endometrial thickness did not change significantly. It is concluded that 17beta-oestradiol improves the signs and symptoms of vaginal atrophy without causing endometrial stimulation and offers a safe and effective alternative to systemic hormone replacement therapy for the treatment of vaginal symptoms associated with post-menopausal oestrogen deficiency.