A qualitative chart review presented at the 2025 Annual Meeting of The Menopause Society found that some perimenopausal and postmenopausal patients using the systemic estradiol acetate vaginal ring experienced a return of symptoms before the intended three-month replacement period. Among 31 patient charts reviewed, 17 used supplemental estrogen during the final weeks, 3 replaced the ring early, and 1 switched formulations. Lead author Rachel Rubin, MD, noted a disconnect between pharmacokinetic expectations and patient experiences. The authors recommended further pharmacokinetic studies and routine serum estradiol monitoring to optimize ring replacement timing.