Clinical Edge

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IVT or Vaginal Ring for Vaginal Dryness

JAMA Oncol; ePub 2016 Nov 10; Melisko, et al

Treatment with a vaginal ring or intravaginal testosterone cream (IVT) in postmenopausal women with early-stage breast cancer (BC) receiving aromatase inhibitors (AIs) over 12 weeks is safe, with vaginal atrophy, sexual interest, and sexual dysfunction improved, a recent study found. Postmenopausal women with hormone receptor (HR)-positive stage I to III BC taking AIs with self-reported vaginal dryness, dyspareunia, or decreased libido were randomized to 12 weeks of IVT or an estradiol vaginal ring. Researchers found:

  • 75 women (mean age 56 years) started treatment; 69 completed 12 weeks of treatment.
  • Mean (range) baseline elevation in estradiol (E2) was 20 (<2 to 127) pg/mL.
  • At baseline, E2 was above the postmenopausal range in 28 of 76 (37%) women.
  • Persistent E2 elevation was observed in none with a vaginal ring and in 4 of 34 (12%) women with IVT.
  • Transient E2 elevation was observed in 4 of 35 (11%) with a vaginal ring and in 4 of 34 (12%) with IVT.
  • Vaginal atrophy and sexual interest and dysfunction improved for all patients.


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. [Published online ahead of print November 10, 2016]. JAMA Oncol. doi:10.1001/jamaoncol.2016.3904.