Vaginal Estradiol Ring or Testosterone Cream for Aromatase–Inhibitor-Associated Genital Atrophy

Adjuvant aromatase inhibitor (AI) therapy is recommended for postmenopausal women with hormone-receptor positive (HR+) breast cancer but often causes vaginal dryness and sexual dysfunction. Off-label use of a vaginal low-dose estradiol ring (VR) or testosterone cream (TC) can mitigate menopausal genital atrophy and improve libido, but the extent to which these treatments might raise serum estradiol (E2) levels remains uncertain.

Investigators at a U.S. cancer center randomized postmenopausal women receiving AIs for HR+ breast cancer who reported vaginal dryness and sexual dysfunction to 12 weeks of a VR or TC. Among 68 participants (mean age, 56), mean baseline E2 levels were 20 pg/mL (and were above the normal postmenopausal threshold of 10…