Vaginal Estrogen Preparations: A Review of Safety and Efficacy for Vaginal Atrophy

Crandall, Carolyn J.

doi:10.1089/154099902762203704

Cited by 57 publications

(72 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because endometrial hyperplasia increases with increasing dose and duration of estrogen exposure, prompt evaluation of uterine bleeding occurring in this context is warranted. 5 There has been little research on the safety of low-dose vaginal estrogen in women with estrogen-sensitive tumors. In one study, 69 of 1,472 breast cancer survivors (36 % were estrogen receptor positive (ER+); 48 % were on tamoxifen) received low-dose vaginal estrogen for one year and were followed for 5.5 years.…”

Section: Discussionmentioning

confidence: 99%

Lichen Sclerosus in a Breast Cancer Survivor on an Aromatase Inhibitor: A Case Report

Potter

Moore

2012

J GEN INTERN MED

View full text Add to dashboard Cite

Lichen sclerosus is a commonly misdiagnosed disease that is characterized by thinned, hypopigmented, crinkled skin that often forms a figure-eight shape around the vaginal and anal openings. We present a case of advanced lichen sclerosus in a 53-year-old female patient prescribed a nonsteroidal aromatase inhibitor after the excision of a breast cancer tumor. We present a diagnostic approach to lichen sclerosus by recognizing its common figure-eight pattern, and we review the known causes and treatment of lichen sclerosus. Research has shown that lichen sclerosus is more common in low estrogen states, and thus it is logical that aromatase inhibitors could increase a patient's risk for developing this disease. We therefore propose that all patients prescribed aromatase inhibitors undergo regular vulvo-vaginal exams to rule out lichen sclerosus and other hypoestrogen-related vulvo-vaginal problems.

show abstract

Section: Discussionmentioning

confidence: 99%

Lichen Sclerosus in a Breast Cancer Survivor on an Aromatase Inhibitor: A Case Report

Potter

Moore

2012

J GEN INTERN MED

View full text Add to dashboard Cite

show abstract

“…Randomized controlled trials comparing the effectiveness, safety, and acceptability of various vaginal estrogens have been reviewed extensively. 66,87 All forms of vaginal estrogen administration (cream, tablet, ring) are effective. 66,87 Overall adverse events (vaginal irritation, discharge, bleeding, urinary incontinence, ring expulsion in the setting of previous hysterectomy, breast enlargement, edema, migraine) are infrequent.…”

Section: Counselingmentioning

confidence: 99%

“…66,87 All forms of vaginal estrogen administration (cream, tablet, ring) are effective. 66,87 Overall adverse events (vaginal irritation, discharge, bleeding, urinary incontinence, ring expulsion in the setting of previous hysterectomy, breast enlargement, edema, migraine) are infrequent. 87 Long-term, intravaginal use of estrogen cream should be avoided as it results in significant systemic absorption.…”

Section: Counselingmentioning

confidence: 99%

See 1 more Smart Citation

A 60-Year-Old Woman With Sexual Difficulties

Potter

2007

JAMA

View full text Add to dashboard Cite

Ms B is a 60-year-old woman with diabetes, hypertension, hyperlipidemia, and asthma who has noted sexual difficulties since entering menopause. She wonders whether this is normal or whether anything can be done.Ms B had menarche at 12 years of age. She has been happily married for 38 years and has had 3 pregnancies and 3 children. She reports a diagnosis of endometriosis when she was younger but had no difficulty conceiving. She had regular menses until age 58, when she underwent simultaneous bladder suspension surgery for incontinence and hysterectomy for uterine fibroids. Several months postoperatively she began noticing vaginal dryness, decreased sexual desire, and more difficulty achieving an orgasm. She was treated with esterified estrogen (0.625 mg) and methyltestosterone (1.25 mg) at the time with resolution of her symptoms. She continued this regimen for a couple of years, after which it was stopped due to concerns about adverse effects. More recently she has been treated with estradiol vaginal tablets and subsequently switched to an estradiol vaginal ring because of its ease of use. Ms B found that both of these helped with the vaginal dryness but not her other symptoms. She was recently seen by a new primary care physician who suggested trying bupropion (100 mg daily). Her last Papanicolaou test was done a couple months ago and her last mammogram was done about a year ago; results of both were normal.She was recently diagnosed with diabetes and is now treated with metformin (500 mg daily), with a hemoglobin A 1C value of 7.6%. She was also recently noted to have hyperlipidemia and was prescribed pravastatin (40 mg daily) for a total cholesterol level of 307 mg/dL (7.95 mmol/L), high-density lipoprotein (HDL) cholesterol level of 57 mg/dL (1.48 mmol/L), and a calculated low-density lipoprotein (LDL) level of 229 mg/dL (5.93 mmol/L). Her blood pressure has been well controlled with lisinopril (20 mg daily). She has allergic asthma that is well controlled with montelukast (10 mg daily). She notes occasional back pain for which she takes cyclobenzaprine (two 10-mg tablets at bedtime) with good relief. She is allergic to ciprofloxacin with development of a rash.She currently works as a psychologist. She walks 45 minutes daily, has never smoked, and denies any significant alcohol intake. MS B: HER VIEWMy perception of it isn't so much as a dysfunction as an awareness that since menopause, a few years before actual menopause, that it was more of a challenge to really focus on my own sexuality and that upon arousal, when my husband and I would make love, that it takes a little more work now. I just started to feel nowhere near as much desire as I normally did. Things were not as stimulating, and it just became a challenge instead of an adventure.

show abstract

“…Therefore, some clinicians advocate long-term, low-dose therapy for the maintenance of vaginal health. There are conflicting data that vaginal estrogens also may reduce urinary frequency and recurrent urinary tract infections 3 .…”

mentioning

confidence: 99%

Is endometrial monitoring required with the use of long-term unopposed vaginal estrogen?

MacLennan¹,

Sturdee²

2006

Climacteric

View full text Add to dashboard Cite

Vaginal Estrogen Preparations: A Review of Safety and Efficacy for Vaginal Atrophy

Abstract: All preparations are effective in decreasing signs and symptoms of vaginal atrophy, but they differ slightly in their adverse event profiles. Long-term safety of the preparations is best established for estradiol tablets (1 year), but is lacking for all preparations.

Cited by 57 publications

References 35 publications

Lichen Sclerosus in a Breast Cancer Survivor on an Aromatase Inhibitor: A Case Report

Lichen Sclerosus in a Breast Cancer Survivor on an Aromatase Inhibitor: A Case Report

A 60-Year-Old Woman With Sexual Difficulties

Is endometrial monitoring required with the use of long-term unopposed vaginal estrogen?

Contact Info

Product

Resources

About