Objective To analyze the effect of regular local application of estrogen combined with lactobacillus capsule in the treatment of senile atrophic vaginitis. Methods A total of 84 elderly patients with atrophic vaginitis admitted to our hospital from May 2021 to May 2022 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 42 cases in each group. The control group was treated with lactobacillus capsules, and the observation group was treated with estrogen combined with lactobacillus capsules. The clinical efficacy, satisfaction, quality of life, negative emotions, vaginal pH value and adverse reactions were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group (P<0.05). The satisfaction of the observation group was higher than that of the control group (P<0.05). The SF-36 score, vaginal pH value, SAS and SDS scores of the observation group were better than those of the control group (P<0.05). The total incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05). Conclusion Regular local application of estrogen and lactobacillus capsules can effectively treat senile atrophic vaginitis, improve the quality of life and satisfaction, promote the improvement of symptoms, and have high safety.