Clinical Trial: A Trial to Evaluate the Efficacy of Low Dose Vaginal Estrogens in the Treatment of Atrophic Vaginitis

Study Status: Terminated
Recruit Status: Terminated
Study Type: Interventional

Official Title: A Randomized Controlled Trial to Evaluate the Efficacy of Low Dose Vaginal Estrogens in the Treatment of Atrophic Vaginitis

Brief Summary:

Atrophic vaginitis is a common problem that occurs in up to 40% of postmenopausal women. The main symptoms are dryness, itching and burning in and around the vagina. These symptoms in turn can cause pain with intercourse. Other symptoms can include urinary frequency and urinary urgency. These symptoms are caused by the decreasing levels of estrogens in postmenopausal women.

The current treatment options include hormone replacement therapy by mouth and patch and vaginal creams, tablets and rings. The current guideline recommend using hormone therapy at the lowest dose for the shortest time. We are trying to find the lowest effective dose of estrogen cream that helps with symptoms without causing an increase in estrogens in the blood stream.

We want to compare two estrogen creams, estradiol and estriol, each at very low doses, with a placebo cream. Estradiol cream is available on prescription but we want to see how effective it is at one tenth the commonly prescribed dose. Estriol cream is not commonly prescribed and is only available at compounding pharmacies. We want to see if either of these estrogens is effective at one tenth the usual dose. We also want to see if these creams are effective when massaged onto the outer part of the vagina, rather than the usual method of treatment, which is inserting them into the vagina.


Detailed Summary: This trial will measure the effects of very low doses of estradiol or estriol cream applied to the vaginal introitus for the treatment of atrophic vaginitis, a common condition affecting up to 40% of postmenopausal women. We will conduct a randomized controlled trial with three arms-estradiol, estriol and placebo. The intervention will last for 12 weeks. The outcomes we will be most interested in are the efficacy of the treatments for symptoms of atrophic vaginitis compared to placebo and whether there is any measurable systemic absorption from the locally applied estrogen creams. These outcomes will be measured, primarily, by the use of patient questionnaires and secondarily, clinical examination scores. Safety will be evaluated with serum estrogen concentrations. All measures will be collected at baseline and at the termination of the study. Hormone concentrations will be collected, additionally, at week 2. This trial will answer important questions regarding the impact of very low doses of locally applied estrogens and symptoms of atrophic vaginitis. It will provide information on effect size and validity of outcome measures. It will also give information about whether low doses of estrogen creams, locally applied to the vaginal introitus, result in systemic absorption
Sponsor: Maire Mac Bride

Current Primary Outcome: Change in Vulvovaginal Atrophy Questionnaire (VVAQ) Scores From Baseline to Week 12 [ Time Frame: baseline, 12 weeks ]

The VVAQ consists of three questions asking the participant to rate the severity and how bothersome each of the symptoms of atrophic vaginitis are (dryness, itching, and burning). It is graded 0 through 10. A higher number indicates less severe and less bothersomeness of the symptom, that is, 0= very severe or bothersome, 10= least severe or bothersome.


Original Primary Outcome: To determine whether low dose estrogen (10 mcg of estradiol cream or 10 mcg of estriol cream) applied topically twice weekly to the vaginal introitus in postmenopausal women with atrophic vaginitis (AV) relieves the severity symptoms of AV. [ Time Frame: 12 weeks ]

Current Secondary Outcome:

  • Change in Serum Estrone (E1) Levels Between Baseline, 2 Weeks, and 12 Weeks [ Time Frame: baseline, 2 weeks, 12 weeks ]
  • Change in Serum Estradiol (E2) Levels Between Baseline, 2 Weeks, and 12 Weeks [ Time Frame: baseline, 2 weeks, 12 weeks ]


Original Secondary Outcome: To evaluate the systemic absorption of 10 micrograms of estradiol and 10 micrograms of estriol cream applied topically to the vaginal introitus twice weekly. [ Time Frame: 12 weeks ]

Information By: Mayo Clinic

Dates:
Date Received: December 30, 2008
Date Started: October 2008
Date Completion:
Last Updated: February 12, 2014
Last Verified: February 2014