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Complication of a 2-mg estradiol vaginal ring: fibrotic vaginal adhesion

Pratts, Meghan E. MD; Shen, Wen MD

doi: 10.1097/GME.0000000000000262
Case Report

Objective This work aims to review a novel case of a retained 2-mg estradiol vaginal ring used to treat postmenopausal urogenital atrophy. The ring was found adhered to the posterior fornix by a fibrotic band. This is the first reported case in the medical literature.

Methods We describe the case of a postmenopausal woman experiencing symptoms of urogenital atrophy. Factors predisposing her to this complication (such as inconsistent use of other forms of vaginal estradiol, initial incorrect use of the ring with two rings in place, and subsequent vaginal stenosis and irritation requiring vaginal dilator therapy at one point in her treatment course) were analyzed. A review of the medical literature was performed to examine the safety profile of estradiol vaginal rings used to treat urogenital atrophy and to investigate the incidence of complications.

Results Two-milligram estradiol vaginal rings treat symptoms of urogenital atrophy by delivering a constant supply of estradiol to the vaginal epithelium. The ring has been shown to be as safe and effective as other forms of vaginal estrogen. Vaginal irritation is a known complication of 2-mg estradiol vaginal rings and other vaginal implants; however, none of the randomized controlled trials that have compared the ring to other vaginal estrogen forms have reported adherence of the ring to the vaginal epithelium.

Conclusions Providers should be aware of the possibility of ring adherence to the vaginal epithelium and should exercise caution in using the 2-mg estradiol vaginal ring in women with significant vaginal stenosis or irritation.

From the Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Received February 10, 2014; revised and accepted March 25, 2014.

Funding/support: None.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Meghan E. Pratts, MD, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Phipps 279, GYN/OB, 600 N Wolfe St, Baltimore, MD 21287. E-mail:

© 2014 by The North American Menopause Society.