The use of an estradiol-releasing vaginal ring or intravaginal testosterone cream (IVT) is safe and efficacious for reducing urogenital atrophy among postmenopausal women with breast cancer receiving aromatase inhibitor (AI) therapy, according to an article published in JAMA Oncology.1

The adverse events associated with AI therapy in early-stage, hormone-receptor positive breast cancer are linked with reduced treatment compliance and lower quality of life. One effect of AI therapy is reduced estradiol in the bloodstream, which is essential for the maintenance of female reproductive tissue.

To determine the optimal treatment of AI-related adverse events, researchers conducted a randomized phase 2 trial ( Identifier: NCT00698035) evaluating the safety and efficacy of IVT vs that of an estradiol-releasing vaginal ring.

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Of the 76 patients enrolled, 35 patients were randomized to and completed 12 weeks’ treatment with the vaginal ring; 33 patients were randomized to and completed 12 weeks’ treatment with IVT.

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Both IVT and the vaginal ring were safe and efficacious for treating urogenital symptoms in this patient population. Baseline estradiol levels were, however, higher than expected, a finding that ought to be investigated further, according to the study’s authors.


  1. Melisko ME, Goldman ME, Hwang J, et al. Vaginal testosterone cream vs estradiol vaginal ring for vaginal dryness or decreased libido in women receiving aromatase inhibitors for early-stage breast cancer: A randomized clinical trial. JAMA Oncol. 2016 Nov 10. doi: 10.1001/jamaoncol.2016.3904 [Epub ahead of print]