At The Menopause Society's Annual Meeting, investigators reported that patients who are perimenopausal and postmenopausal using the systemic estradiol acetate vaginal ring often experienced a loss of symptom control before the device’s intended 90-day duration.
Among 31 patients with documentation describing the ring “wearing off,” most reported a return of vasomotor symptoms during the final weeks of use. Seventeen patients supplemented therapy with an estrogen patch or gel in the last 2 to 4 weeks, 3 replaced the ring early, and at least 1 switched entirely to another formulation.
The qualitative chart review evaluated patient records from a single private practice to describe real-world experiences with the estradiol acetate vaginal ring. Researchers performed a free-text search of electronic medical records using the exact phrases “wears off,” “runs out,” and “ring not enough.” Direct quotations from encounter notes and any available serum estradiol levels were analyzed to characterize symptom-recurrence patterns. Thirty-one qualifying charts were identified, including 11 perimenopausal and 20 postmenopausal patients, 1 of whom had surgical menopause.
Serum estradiol measurements were inconsistently documented, limiting the ability to correlate pharmacokinetic data to clinical symptoms. Because the study relied on retrospective chart review, documentation variability and recall bias may have influenced results. The authors noted that some patients had overlapping treatments, which in some cases made it difficult to determine the precise timing of symptom recurrence.
Lead study author Rachel Rubin, MD, and colleagues, stated that the assessment “highlights a disconnect between the pharmacokinetic expectations of the three-month estradiol vaginal ring and the lived experience of some patients using it, which in some cases greatly impacts the quality of life of these women.”
The researchers reported no funding sources and no conflicts of interest or competing interests related to this study.