From the Guidelines
Estrione is effective for vaginal atrophy, as evidenced by a study in 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy, which found that intravaginal testosterone cream or an estradiol-releasing vaginal ring were safe and improved vaginal atrophy and sexual function 1.
Key Points
- Vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1.
- A large cohort study of almost 50,000 patients with breast cancer followed for up to 20 years showed no evidence that there was a higher risk of breast cancer–specific mortality in those using vaginal estrogen 1.
- Estrione, as a form of vaginal estrogen, can be considered for survivors with sexual dysfunction, particularly those with vaginal dryness or pain with sexual activity.
Treatment Considerations
- Typical regimens for vaginal estrogen therapy include daily application for 2-3 weeks, followed by maintenance therapy of 1-2 applications per week.
- Common formulations include 0.5-1 mg estradiol per dose, which works primarily locally with minimal systemic absorption, making it a safer option than systemic estrogen therapy for many women.
- Women with a history of estrogen-dependent cancers, unexplained vaginal bleeding, or certain thromboembolic disorders should consult their healthcare provider before using estrione, as individualized assessment is necessary.
Alternative Options
- Ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), has been studied in several large trials of individuals with postmenopausal vulvar and vaginal atrophy and was found to effectively treat vaginal dryness and dyspareunia 1.
- Vaginal androgens (ie, DHEA, also known as prasterone) can also be considered for vaginal dryness or pain with sexual activity, although safety data for the use of androgen-based therapy in survivors of hormonally mediated cancers are limited 1.
From the Research
Effectiveness of Estrione for Vaginal Atrophy
- There are no direct studies on the effectiveness of estrione for vaginal atrophy in the provided evidence.
- However, studies have shown that topical estrogen therapies, such as vaginal estrogen preparations, are effective in relieving symptoms of vaginal atrophy 2, 3.
- Ospemifene, a non-hormonal selective estrogen receptor modulator, has also been shown to be effective in treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy 4, 5.
- A systematic review comparing the efficacy of vaginal hyaluronic acid to estrogen for the treatment of vaginal atrophy in postmenopausal women found that estrogen was superior to hyaluronic acid in relieving vaginal symptoms, but hyaluronic acid can be used as an alternative to estrogen in patients who do not want to use estrogen 6.
Alternative Treatments for Vaginal Atrophy
- Topical estrogen therapies, such as vaginal estrogen preparations, are effective in relieving symptoms of vaginal atrophy 2, 3.
- Ospemifene, a non-hormonal selective estrogen receptor modulator, is effective in treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy 4, 5.
- Vaginal hyaluronic acid can be used as an alternative to estrogen in patients who do not want to use estrogen 6.