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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.

Bruce D. Shephard, MD
shephardmd@verizon.net
Department of Obstetrics and Gynecology
University of South Florida College of Medicine
Tampa

1. Potter JE. A 60-year-old woman with sexual difficulties. JAMA. 2007;297:620-633. FREE FULL TEXT 2. Warner Chilcott. Femring prescribing information. http://www.warnerchilcott.com/products/femring/index.php. Accessed April 3, 2007.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297:2076.