REVIVE: Replens Versus Intra-Vaginal Estrogen for the Treatment of Vaginal Dryness on Aromatase Inhibitor Therapy

To evaluate Estring versus Replens for treatment of atrophic vaginitis in breast cancer
survivors on adjuvant aromatase inhibitor therapy.

PRIMARY OBJECTIVE 1. To compare improvement of atrophic vaginitis signs and symptoms between
women on the vaginal estrogen ring and those on Replens vaginal cream. 1.1 Administer a
questionnaire at baseline, 4 weeks, 12 weeks, and 24 weeks to all patients which will assess
vaginal dryness and vaginal itching. Over six months, we expect that patients who are
receiving vaginal estrogen will have more improvement in atrophic vaginitis symptoms as
compared to those women on Replens.

SECONDARY OBJECTIVES 2.1 Assess compliance with aromatase inhibitor (AI) therapy in each arm
to see whether vaginal estrogen therapy increases AI compliance among women who have atrophic
vaginitis. Compliance will be checked by counting pills at clinic visits at 4 weeks, 12
weeks, and 24 weeks during the study treatment period, and then every 6 months for a period
of 4.5 additional years, or until completion of aromatase inhibitor therapy. We expect that
compliance in the vaginal estrogen arm will be superior to that of the Replens arm.

Women over the age of 18 who have been diagnosed with stage I-III ER+ breast cancer and are
currently taking adjuvant AI therapy who also complain of atrophic vaginitis symptoms
including vaginal dryness, vaginal itching, frequent urinary tract infections, or dyspareunia
are candidates for this study. Women also must be post-menopausal as defined by any of the
following: age >55 years, history of bilateral oophorectomy, amenorrhea for 1 year with
intact uterus and ovaries, or serum estradiol and FSH concentrations in the post-menopausal
range along with either amenorrhea for 6 months or previous hysterectomy.

Inclusion Criteria:

1. be female

2. be 18 years of age or older.

3. have stage I-III ER+ breast cancer

4. be post-menopausal as defined by any of the following: age >55 years, history of
bilateral oophorectomy, amenorrhea for 1 year with intact uterus and ovaries, or serum
estradiol and FSH concentrations in the post-menopausal range along with either
amenorrhea for 6 months or previous hysterectomy.

5. currently take adjuvant AI therapy

6. have vaginal dryness, dyspareunia, or ≥3 urinary tract infections per year since
starting AI therapy

7. Patients must agree not to use any additional estrogen during the five year study
period. However, use of non-estrogen containing lubricants prior to sexual
intercourse, or otherwise, is allowed.

Exclusion Criteria:

1. use of any exogenous estrogen within the preceding four weeks

2. current vaginal infection.