Safety and Value of the Estring

As some of you know, the estring (estradiol vaginal ring) is a device sometimes prescribed to help with moderate to severe vaginal symptoms after menopause. This translates to treatment for vaginal dryness and discomfort/pain with intercourse (and sometimes just in the course of normal living). Since the estring works by slowly releasing estrogen directly into vaginal tissues, there are concerns about safety for women who have been treated for breast cancer, especially for estrogen positive breast cancer.

Very honestly, not so much is known about its' efficacy and safety, and the recommendation has always been "talk with your doctor". It has been, and really continues to be, a personal decision based on one woman's cancer experience as well as her quality of life issues. I have known women who used estrings and found some relief, and others who were told by their oncologists that it would not be wise.

JAMA Oncology has just published the first study to look at the safety and value of the estring for post menopausal women who are taking AIs. The main conclusion of the study was: In postmenopausal women with early-stage breast cancer receiving AIs, treatment with a vaginal ring or IVT over 12 weeks met the primary safety end point. Baseline elevation in E2 was common and complicates this assessment. Vaginal atrophy, sexual interest, and sexual dysfunction were improved. Further study is required to understand E2 variability in this setting. The conclusions are not so straightforward, so more research needs to be done, and this continues to be an "ask your doctor" situation.

Here is the link to read more:

Vaginal Testosterone Cream vs Estradiol Vaginal Ring for Vaginal Dryness or Decreased Libido in Women Receiving Aromatase Inhibitors for Early-Stage Breast Cancer