Pros and Cons of Estrogen Ring?
I am considering using an estrogen ring. What are the benefits and risks? Does the ring increase the risks of developing breast or uterine cancer? Would you recommend it to your sister?
By Dr. Martee L Hensley
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The estrogen ring is a form of estrogen-replacement therapy in which the estrogen is delivered directly to the vagina. The estrogen is slowly released from a small, flexible ring that is inserted into the vagina and kept inside for three months at a time. Women are not generally aware of the ring and are able to have intercourse without their partner being aware of it.
This ring is one of several types of vaginal estrogen therapy typically used in menopausal women who are suffering from vaginal dryness and irritation, which is thought to be related to the decrease in estrogen that accompanies menopause (though the ring probably won't provide significant relief from hot flashes or prevent osteoporosis). Other vaginal estrogen therapies include vaginal estrogen creams and a vaginal estrogen tablet.
The vaginal estrogen ring and the vaginal estrogen tablet release about one-tenth the dose of estrogen into the bloodstream compared to taking estrogen-replacement medicines by mouth or skin patch. Vaginal estrogen creams deliver an estrogen dose that is closer to that of oral estrogen replacement. Since the vaginal ring and the tablet lead to lower levels of circulating estrogen in the bloodstream compared to taking estrogen by mouth or a skin patch, they are appealing options for women and physicians who are concerned about the risks of estrogen-replacement therapy. It is felt that the risks of cancer, vaginal bleeding, and blood clots are less with these two vaginal forms of low-dose estrogen. In fact, studies have been done to measure the level of circulating estrogen in women before and after using the estrogen ring and have found that the amount of circulating estrogen remains in the menopause range during use of the estrogen ring.
Vaginal estrogen treatment with the ring or the tablet is a reasonable choice for women with menopause-related vaginal dryness. Since the level of circulating estrogen remains in the menopause range in most women using the ring or the vaginal tablet, many doctors are fairly comfortable with the short-term use of these medicines even in women with a history of breast cancer, ovary cancer, or endometrial cancer. All women with a history of cancer should thoroughly discuss the safety of vaginal estrogen use with their doctors. Women who have a uterus still in place should also discuss how many months of therapy is safe for them, as there is only limited data for use beyond about six months. Finally, vaginal estrogens are not appropriate for women who are pregnant or breastfeeding, have a history of abnormal blood clots, currently have breast cancer, or have vaginal bleeding of unknown cause. If vaginal bleeding starts during the use of vaginal estrogens make sure you are thoroughly evaluated. The same is true foranyvaginal bleeding that occurs after menopause.
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