title: Vaginal estriol to overcome side-effects of aromatase inhibitors in breast cancer patients.
abstract: OBJECTIVE
  Aromatase inhibitors are essential as endocrine treatment for hormone receptor-positive postmenopausal breast cancer patients. Menopausal symptoms are often aggravated during endocrine treatment. We investigated whether vaginal estriol is a safe therapeutic option to overcome the urogenital side-effects of aromatase inhibitors. Serum hormone levels were used as the surrogate parameter for safety.
  
  
  METHODS
  Fasting serum hormone levels of ten postmenopausal breast cancer patients receiving aromatase inhibitors were prospectively measured by electro-chemiluminescence immunoassays and gas chromatography/mass spectrometry before and 2 weeks after daily application of 0.5 mg vaginal estriol (Ovestin® ovula), respectively.
  
  
  RESULTS
  Two weeks of daily vaginal estriol treatment did not change serum estradiol or estriol levels. However, significant decreases in levels of serum follicle stimulating hormone (p = 0.01) and luteinizing hormone (p = 0.02) were observed. Five out of six breast cancer patients noticed an improvement in vaginal dryness and/or dyspareunia.
  
  
  CONCLUSIONS
  The significant decline in gonadotropin levels, indicating systemic effects, has to be kept in mind when offering vaginal estriol to breast cancer patients receiving an aromatase inhibitor.
authors.affiliation: Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Pfeiler
authors.forename: C
authors.initials: C
authors.lastname: Glatz
authors.forename: R
authors.initials: R
authors.lastname: Königsberg
authors.forename: T
authors.initials: T
authors.lastname: Geisendorfer
authors.forename: A
authors.initials: A
authors.lastname: Fink-Retter
authors.forename: E
authors.initials: E
authors.lastname: Kubista
authors.forename: C F
authors.initials: CF
authors.lastname: Singer
authors.forename: M
authors.initials: M
authors.lastname: Seifert
mesh_terms: D000282:Administration, Intravaginal; D047072:Aromatase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D002849:Chromatography, Gas; D016903:Drug Monitoring; D004414:Dyspareunia / Q000139:chemically induced; D004964:Estriol / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D052776:Female Urogenital Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000378:metabolism; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007118:Immunoassay; D007986:Luteinizing Hormone / Q000097:blood; D017060:Patient Satisfaction; D017698:Postmenopause / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D047072:Aromatase Inhibitors; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D004964:Estriol