Breast Cancer Research and Treatment

, Volume 157, Issue 2, pp 203–210 | Cite as

Vaginal estrogen products in hormone receptor-positive breast cancer patients on aromatase inhibitor therapy

  • Elisabeth Sulaica
  • Tiffany Han
  • Weiqun Wang
  • Raksha Bhat
  • Meghana V. Trivedi
  • Polly Niravath


Atrophic vaginitis represents a major barrier to compliance with aromatase inhibitor (AI) therapy in breast cancer (BC) survivors. While local estrogen therapy is effective for postmenopausal vaginal dryness, the efficacy of such therapies has not been evaluated systematically in hormone receptor-positive (HR+) BC patients on AI therapy. Furthermore, the potential risk of breast cancer recurrence with vaginal estrogen therapy represents a long-term safety concern for the patients with HR + BC. Unfortunately, there is no standardized assay to measure very low concentrations of estradiol (E2) in these women being treated with AI therapy. This makes it difficult to evaluate even indirectly the potential risk of BC recurrence with vaginal estrogen therapy in HR + BC patients on AI therapy. In this review, we describe available assays to measure very low concentrations of E2, discuss the Food and Drug Administration-approved vaginal estrogen products on the market, and summarize published and ongoing clinical trials evaluating the safety and efficacy of vaginal estrogen in HR + BC patients on AI therapy. In the absence of any randomized controlled clinical trials, this review serves as a summary of available clinical data and ongoing studies to aid clinicians in selecting the best available option for their patients.


Vaginal symptoms Vaginal atrophy Vaginal estradiol Vaginal estrogen Vaginal estriol Aromatase inhibitor Hormone receptor Breast cancer 


Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Elisabeth Sulaica
    • 1
  • Tiffany Han
    • 1
  • Weiqun Wang
    • 1
  • Raksha Bhat
    • 1
  • Meghana V. Trivedi
    • 1
    • 2
  • Polly Niravath
    • 2
  1. 1.Department of Pharmacy Practice and Translational ResearchUniversity of Houston College of PharmacyHoustonUSA
  2. 2.Lester and Sue Smith Breast CancerBaylor College of MedicineHoustonUSA

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