To the Editor:
I read the article, “A new verdict for hormone therapy: Safe for younger women,” in the December issue of JAAPA. This paragraph is misleading:
“Unopposed estrogen should be administered as a vaginal preparation. Local estrogen is highly effective and is preferred over systemic estrogen for women with only vaginal symptoms. Systemic absorption is limited with vaginal preparations; therefore, concomitant progestogen is not indicated.10 Local estrogen, however, has no effect on vasomotor symptoms or osteoporosis prevention, and this should be explained to patients.”
Unopposed estrogen can be administered either orally or transdermally. If a woman is only having symptoms of vaginal atrophy, local estrogen as a vaginal preparation is preferred. Unopposed estrogen refers to estrogen given to a woman who has no uterus, thus doesn't need progestogen protection.
The vaginal preparation FemRing has systemic levels of estrogen and does require progestogen protection for the uterus. The other vaginal preparations, including the creams (if a low dose is used twice a week), tablets, and Estring release a very low dose of estrogen and have not shown to increase the risk of endometrial hyperplasia in the 1 year in which these products have been studied.
Linda Burdette, MPAS, PA-C
Association of PAs in OB/GYN