Accelerated Genital Tract Aging in HIV: Estradiol Clinical Trial

Inclusion Criteria: * HIV infection * Females aged 45-70 * Menopause defined by having no menstrual periods for 12 consecutive months, confirmed with serum follicle-stimulating hormone (FSH) level \>40 IU/ml and serum estradiol level \<20 pg/ml * Symptomatic vaginal atrophy defined as reporting at least once per week in the past 30 days, 1 or more of the following symptoms of moderate or severe intensity: Dryness, Itching, Irritation, Soreness or pain OR Pain associated with sexual activity at least once * Evidence of atrophy on exam, including thin, pale and dry vaginal and vulvar surfaces * Agrees not to use vaginal products other than vaginal estradiol tablet during the clinical trial Exclusion Criteria: * Current or previous history of breast cancer or estrogen dependent neoplasia * Current or past thromboembolic disease (deep vein thrombosis or pulmonary embolism, not including thrombophlebitis) * Current or previous history of myocardial infarction or stroke * Known blood clotting disorders including Protein C, Protein S and antithrombin deficiency, Factor V Leiden or prothrombin mutations * Known severe liver disease including cirrhosis or active Hepatitis B * History of adverse reaction to vaginal estradiol * Current unexplained or unevaluated abnormal genital bleeding * Current or suspected pregnancy * If \< age 55, had a hysterectomy and has at least one ovary * Pelvic or vaginal surgery in the prior 60 days * Use of systemic reproductive hormones in the past 2 m…