Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Weisberg, Edith; Ayton, R; Darling, G.; Farrell, Elizabeth; Murkies, Atice L.; O’Neill, Sheila; Kirkegard, Y.; Fraser, Ian S.

doi:10.1080/13697130500087016

Cited by 149 publications

(106 citation statements)

References 19 publications

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“…Most E2 administration involves oral, transdermal, s.c., or i.v. injections, with the exception of the vaginal ring (52,53). However, a local E2 delivery system specifically for skeletal effects has yet to be developed despite the fact that E2 has been well established as a key agent in bone health.…”

Section: Discussionmentioning

confidence: 99%

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

Hong

Song

Lee

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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Patients with cleft lip and/or palate (CLP), who undergo numerous medical interventions from infancy, can suffer from lifelong debilitation caused by underdeveloped maxillae. Conventional treatment approaches use maxillary expansion techniques to develop normal speech, achieve functional occlusion for nutrition intake, and improve esthetics. However, as patients with CLP congenitally lack bone in the cleft site with diminished capacity for bone formation in the expanded palate, more than 80% of the patient population experiences significant postexpansion relapse. While such relapse has been a long-standing battle in craniofacial care of patients, currently there are no available strategies to address this pervasive problem. Estrogen, 17β-estradiol (E2), is a powerful therapeutic agent that plays a critical role in bone homeostasis. However, E2's clinical application is less appreciated due to several limitations, including its pleiotropic effects and short half-life. Here, we developed a treatment strategy using an injectable system with photo-crosslinkable hydrogel (G) and nanodiamond (ND) technology to facilitate the targeted and sustained delivery of E2 to promote bone formation. In a preclinical expansion/relapse model, this functionalized E2/ ND/G complex substantially reduced postexpansion relapse by nearly threefold through enhancements in sutural remodeling compared with unmodified E2 administration. The E2/ND/G group demonstrated greater bone volume by twofold and higher osteoblast number by threefold, compared with the control group. The E2/ND/G platform maximized the beneficial effects of E2 through its extended release with superior efficacy and safety at the local level. This broadly applicable E2 delivery platform shows promise as an adjuvant therapy in craniofacial care of patients.nanomedicine | cleft palate | craniofacial medicine | nanodiamond | drug delivery

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Section: Discussionmentioning

confidence: 99%

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

Hong

Song

Lee

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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“…4). A drop in serum estradiol levels following consistent use with either Estring or Vagifem has also been well documented among menopausal women without a prior history of breast cancer [51,64]. This fall in serum estradiol levels is likely a reflection of vaginal epithelial maturation, which further inhibits systemic absorption of estrogen.…”

Section: Ert Use Among Women With a Prior Diagnosis Of Breast Cancermentioning

confidence: 96%

“…The time to improved symptoms with topical vaginal estrogens is roughly 4 weeks [49]. Importantly, Vagifem and Estring have not been found to significantly increase endometrial thickness after 48 weeks of treatment [51].…”

Section: Management Of Urogenital Symptoms In the Non-breast Cancer Pmentioning

confidence: 99%

“…Estring is inserted into the upper vagina where it remains for up to 3 months while releasing 5-10 g per day of estradiol. Estring and Vagifem have demonstrated an approximate 90% improvement in relief of the symptoms of atrophic vaginitis: vaginal dryness, itching, and discharge [48,50,51]. Both agents have been shown to dramatically reduce the frequency of urinary tract infections among postmenopausal women [52,53].…”

Section: Management Of Urogenital Symptoms In the Non-breast Cancer Pmentioning

confidence: 99%

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Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens?

et al. 2008

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Disclosure:The article discusses Replens (Wellspring Pharmaceutical) as a vaginal lubricant/moisturizer and Estring (Pfizer) and Vagifem (Novo Nordisk) as topical estrogen replacements. W.W. has received an honorarium from Wyeth and Berlex as a guest speaker at CME events. No other potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article. LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the urogenital consequences of antiestrogen treatment among women with a prior diagnosis of breast cancer and the effects that these side effects have on quality of life and medication compliance.2. Advise on the standard treatment of urogenital atrophy, including alternatives to topical estrogen replacement, in the non-breast cancer and breast cancer populations.3. Evaluate the evidence for the current recommendations of estrogen replacement therapy among women with a prior diagnosis of breast cancer.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTBreast cancer survivors represent a unique patient population with a high prevalence of menopausal symptoms. Given the improved longevity of cancer patients, the consequences of menopause have become an increasingly important and challenging management issue. To date, considerable attention has been paid to the management of menopausal vasomotor symptoms and bone health among breast cancer patients. As a result, numerous nonhormonal treatment options have been developed for the management of these issues. The treatment of urogenital symptoms among this population is poorly understood and relatively understudied. Although systemic or topical estrogen replacement is the most effective method for treating hypoestrogenemic urogenital symptoms, women with a prior diagnosis of breast cancer are cautioned from taking exogenous estrogens in order to avoid a potential contribution to recurrent breast cancer risk. This review focuses on the urogenital consequences of estrogen deprivation therapy in breast cancer patients and provides practitioners with a simple guide of current and future strategies for managing these symptoms. The Oncologist 2008;13:222-231

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“…Blood flow to the vagina is also reduced, leading to decreased transudation during sexual arousal as well as increased risk of trauma and pain (Johnston et al, 2004). The rise in the vaginal pH, as well as thinning of the epithelium, increases the incidence of urinary tract yeast infections in women during perimenopause and after menopause (Weisberg et al, 2005). The vaginal pH in premenopausal women is less than 4.5, which reflects the production of lactic acid by lactobacillus organisms.…”

Section: Introductionmentioning

confidence: 99%

Effect of hyaluronic acid and vitamin E vaginal tablets on atrophic vaginitis: A randomized controlled trial

Ziagham¹,

Abbaspoor²,

Abbaspour³

2012

Afr. J. Pharm. Pharmacol.

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Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Abstract: Equivalent endometrial safety and efficacy in the relief of the symptoms and signs of urogenital estrogen deficiency were demonstrated for the 12 months' use of a low-dose estradiol-releasing vaginal ring and a vaginal estradiol tablet.

Cited by 149 publications

References 19 publications

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen–nanodiamond hydrogel

Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens?

Effect of hyaluronic acid and vitamin E vaginal tablets on atrophic vaginitis: A randomized controlled trial

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