VEMORA: Vaginal Estrogen versus non-hormonal MOisturizer in women Receiving Aromatase inhibitors: a randomized, controlled trial
In brief
Vaginal estrogen improves dryness and pain more than moisturizer in AI-treated breast cancer survivors
In a small randomized trial of 23 postmenopausal women on aromatase inhibitors, vaginal estrogen reduced vaginal dryness and dyspareunia scores significantly more than a non-hormonal moisturizer over 24 weeks, while vaginal pH also fell. Systemic estradiol stayed low in most patients, but larger, longer studies are needed to confirm safety.
- Journal
- Breast cancer research and treatment (Q1)
- Published
- 30 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Polly Niravath, Mothaffar Rimawi, Kai Sun, Hanh Mai, Akshjot Puri, Anuja Vyas, et al.
- PMID
- 42530772
- DOI
- 10.1007/s10549-026-08025-0
Why clinicians should know about it
- Picked for Dermatology (top studies of the week, 2 August 2026): Vaginal estrogen vs moisturizer in aromatase inhibitor users, breast cancer
- Picked for Oncology and Radiation Oncology (top studies of the week, 2 August 2026): Vaginal estrogen vs moisturizer RCT in AI‑treated breast cancer survivors
- Picked for Geriatrics and Gerontology (paper of the day, 31 July 2026).
Abstract
PURPOSE: Genitourinary Syndrome of Menopause (GSM) remains a significant unmet need for postmenopausal breast cancer survivors receiving aromatase inhibitor (AI) therapy. METHODS: In this randomized, controlled, open-label clinical trial, ER+ breast cancer survivors receiving adjuvant AI therapy with symptomatic GSM were randomized to receive 24 weeks of a non-hormonal vaginal moisturizer (Replens®) or vaginal estrogen therapy (either Vagifem® vaginal tablets or Estring® vaginal ring). The primary endpoint was change in vaginal dryness. Secondary endpoints included dyspareunia, sexual functioning, vaginal pH, and serum estradiol values. RESULTS: Twenty-three patients were enrolled (vaginal estrogen [VE], n = 11; non-hormonal [NH], n = 12). Vaginal dryness and dyspareunia scores improved significantly in the VE arm compared with the NH arm (p = 0.049, p = 0.048, respectively). Vaginal pH decreased significantly with vaginal estrogen compared to non-hormonal therapy (p = 0.0286). Other domains of sexual function (libido, ability to achieve orgasm, sexual satisfaction, and relationship with partner) were not significantly different between the 2 groups. Serum estradiol levels remained low through the first 12 weeks of therapy. Two participants demonstrated estradiol elevations above threshold at 24 weeks (21.8 pg/mL and 16 pg/mL); both reported non-adherence to AI therapy preceding measurement. CONCLUSION: In this randomized study, vaginal estrogen provided greater improvement in vaginal dryness and dyspareunia than non-hormonal therapy in breast cancer survivors. These findings provide prospective evidence supporting symptomatic benefit with minimal systemic estrogen exposure in most patients, although larger studies with longer follow up are needed to define long-term safety and efficacy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.