Concerns About Methodology of a Trial Investigating Vaginal Health During Aromatase Inhibitor Therapy for Breast Cancer

To the Editor In a recent article, Melisko et al¹ reported vaginal estradiol to cause little increase in plasma estradiol levels during treatment with aromatase inhibitors. Their data raise some concerns.

First, they found plasma estradiol levels greater than 10 pg/mL, a value in the upper range for untreated postmenopausal women,^2,3 in 28 of 76 patients despite treatment with an aromatase inhibitor. For some patients, estradiol levels were greater than 50 pg/mL, inconsistent with a postmenopausal status.