To the Editor: The Clinical Crossroads article by Dr Potter1 discussed the use of vaginal estrogen therapy for a 60-year-old woman with sexual difficulties. The article stated that the patient “switched to an estradiol vaginal ring because of its ease of use,” but doesn't note the content of the device. The article later states that “ . . . both tablets and ring relieve atrophy with minimal systemic absorption . . . the addition of progestin to prevent endometrial hyperplasia is generally not advocated . . . ”
While this may be true for a vaginal ring with a lower dose of estradiol (Estring), a vaginal ring containing a higher dose of estradiol (Femring) does provide systemic serum levels of estradiol,2 and progestin therapy may therefore be advisable. The clinical implications and management may be significantly different depending on which ring a patient is using.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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