Skip to content

Estradiol Vaginal Softgel Capsules in Treating Symptoms of Vulvar and Vaginal Atrophy in Postmenopausal Women

A Phase 3, Randomized, Double-blind, Placebo-controlled, Multi-center Trial to Evaluate the Safety and Efficacy of TX-004HR in Postmenopausal Women With Moderate to Severe Symptoms of Vulvar and Vaginal Atrophy

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02253173
Acronym
REJOICE
Enrollment
764
Registered
2014-10-01
Start date
2014-09-30
Completion date
2015-10-31
Last updated
2017-05-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Dyspareunia, Menopause, Painful Intercourse, Vulvovaginal Atrophy

Keywords

VVA, Painful Sex, Postmenopausal

Brief summary

This study will assess the safety and efficacy of a new formulation of vaginal estradiol for the treatment of symptoms of vulvar and vaginal atrophy in postmenopausal women.

Interventions

DRUGEstradiol
DRUGPlacebo

Sponsors

TherapeuticsMD
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
FEMALE
Age
40 Years to 75 Years
Healthy volunteers
No

Inclusion criteria

1. Postmenopausal female subjects between the ages of 40 and 75 years (at the time of randomization) with at least: * 12 months of spontaneous amenorrhea (women \<55 years of age with a history of hysterectomy without bilateral oophorectomy prior to natural menopause must have follicle stimulating hormone (FSH) levels \> 40 mIU/mL), OR * 6 months of spontaneous amenorrhea with follicle stimulating hormone (FSH) levels \> 40mlU/mL OR * At least 6 weeks postsurgical bilateral oophorectomy. 2. ≤5% superficial cells on vaginal cytological smear 3. Vaginal pH \> 5.0 4. Moderate to severe symptom of vaginal pain associated with sexual activity considered the most bothersome vaginal symptom by the subject at screening visit 1A. 5. Moderate to severe symptom of vaginal pain associated with sexual activity at screening visit 1B. 6. Onset of moderate to severe dyspareunia in the postmenopausal years. 7. Subjects should be sexually active (i.e. have sexual activity with vaginal penetration within approximately 1 month of screening visit 1A). 8. Subjects should anticipate having sexual activity (with vaginal penetration) during the conduct of the trial. 9. For subjects with an intact uterus: Subjects must have an acceptable result from an evaluable screening endometrial biopsy. 10. Subjects who have a Body Mass Index (BMI) less than or equal to 38 kg/m2. BMI values should be rounded to the nearest integer (ex. 32.4 rounds down to 32, while 26.5 rounds up to 27). 11. In the opinion of the investigator, the subject will comply with the protocol and has a high probability of completing the study.

Exclusion criteria

1. Use of the following: 1. Oral estrogen-, progestin-, androgen-, or SERM-containing drug products within 8 weeks before screening visit 1A (can enter washout); 2. Use of transdermal hormone products within 4 weeks before screening visit 1A (can enter washout); 3. Use of vaginal hormone products (rings, creams, gels) within 4 weeks before screening visit1A (can enter washout); 4. Use of intrauterine progestins within 8 weeks before screening visit 1A (can enter washout); 5. Use of progestin implants/injectables or estrogen pellets/injectables within 6 months before screening visit 1A (cannot enter washout); 6. Use of vaginal lubricants or moisturizers within 7 days before the screening visit 1B vaginal pH assessment. 2. A history or active presence of clinically important medical disease that might confound the study or be detrimental to the subject, examples include: 1. Hypersensitivity to estrogens; 2. Endometrial hyperplasia; 3. Undiagnosed vaginal bleeding; 4. Have a history of a chronic liver or kidney dysfunction/disorder (e.g., Hepatitis C or chronic renal failure); 5. Thrombophlebitis, thrombosis or thromboembolic disorders; 6. Cerebrovascular accident, stroke, or transient ischemic attack; 7. Myocardial infarction or ischemic heart disease; 8. Malignancy or treatment for malignancy, within the previous 5 years, with the exception of basal cell carcinoma of the skin or squamous cell carcinoma of the skin. A history of estrogen dependent neoplasia, breast cancer, melanoma or any gynecologic cancer, at any time, excludes the subject; 9. Endocrine disease (except for controlled hypothyroidism or controlled non-insulin dependent diabetes mellitus). 3. Recent history of known alcohol or drug abuse. 4. History of sexual abuse or spousal abuse that, in the opinion of the PI, may interfere with the subject's assessment of vaginal pain with sexual activity. 5. Current history of Heavy smoking (more than 15 cigarettes per day) or use of e-cigarettes. 6. Use of an intrauterine device within 12 weeks before screening visit 1A. 7. Use of an investigational drug within 60 days before screening visit 1A. 8. Any clinically important abnormalities on screening physical exam, assessments, ECG, or laboratory tests, such as: 1. Unresolved cervical cytologic smear report of atypical glandular cells of undetermined significance (AGUS) or atypical squamous cells of undetermined significance (ASCUS). Cervical cytologic smear report of low-grade squamous intraepithelial lesion (SIL) or greater, CIN1 or greater, or any reported dysplasia; Subjects with ASCUS are eligible only if high risk human papilloma virus (HPV) result is negative. 2. Unresolved findings suspicious for malignancy on the breast exam; incomplete mammogram result (BI-RADS 0) or unresolved findings suggestive of malignant changes or findings requiring short interval follow-up on the prestudy mammogram (subjects must have mammography result of BI-RADS 1 or 2 to enroll.) Mammogram may be performed within 9 months prior to Visit 2 (randomization) with documentation available. (The site must obtain a copy of the official report for the subject's study file, and it must be verified that the mammogram itself is available if needed for additional assessment); 3. In subjects with intact uterus: have a screening endometrial biopsy sample that is found by both primary pathologists to have endometrial tissue insufficient for diagnosis, no endometrium identified, or no tissue identified. (With the approval of the Medical Monitor, the screening endometrial biopsy may be repeated once); 4. In subjects with intact uterus: an endometrial biopsy report by one central pathologist at screening with one of the following: * Endometrial hyperplasia endometrial cancer, proliferative endometrium, weakly proliferative endometrium, disordered proliferative pattern; OR * Endometrial polyps with hyperplasia, glandular atypia of any degree (e.g., atypical nuclei) or cancer; 5. Vulvar or vaginal inflammatory condition such as a contact or allergic dermatitis, lichen sclerosis or other pathological findings; 6. Presence of suspicious vulvar or vaginal lesions for dysplasia, malignancy or other pathology other than atrophy; 7. Painful genital warts or localized areas of ulceration; 8. A history of active, chronic pelvic pain; 9. Interstitial cystitis; 10. Serum alanine aminotransferase (ALT) or serum aspartate aminotransferase (AST) greater than 1.5 times the upper limit of normal for the laboratory used; 11. Fasting total cholesterol greater than 300 mg/dL (7.77 mmol/L) or triglycerides greater than 300 mg/dL (3.39 mmol/L); 12. Fasting blood glucose greater than 125 mg/dL (6.94 mmol/L) with a hemoglobin A1C of greater than or equal to 6.5%; 13. Uncontrolled hypertension; subjects with elevated sitting blood pressure, greater than 140 mm Hg systolic or greater than 90 mm Hg diastolic and may not be using more than 2 antihypertensive medications for the treatment of hypertension; 14. Clinically significant abnormal 12-lead ECG (such as myocardial infarction or other findings suggestive of ischemia) 9. Be known to be pregnant or have a positive urine pregnancy test. (Note: A pregnancy test is not required for subjects who have had bilateral tubal ligation, bilateral oophorectomy, hysterectomy, or are 55 years old or greater and have experienced cessation of menses for at least 1 year. 10. Current use of marijuana.

Design outcomes

Primary

MeasureTime frameDescription
Co-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)Baseline and Week 12• Change from Baseline to Week 12 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 12
Co-Primary Efficacy Endpoint - Vaginal Superficial CellsBaseline and 12 Weeks• Change from Baseline to Week 12 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo
Co-Primary Efficacy Endpoint - Vaginal Parabasal CellsBaseline and 12 Weeks• Change from Baseline to Week 12 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo
Co-Primary Efficacy Endpoint - Vaginal pHBaseline and 12 Weeks• Change from Baseline to Week 12 in vaginal pH as compared to placebo

Secondary

MeasureTime frameDescription
Secondary Efficacy Endpoints - Vaginal pHBaseline and Week 2Change from Baseline to Week 2 in vaginal pH as compared to placebo
Secondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)Baseline and Week 2Change from Baseline to Week 2 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2
Secondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)Baseline and Week 2Change from Baseline to Week 2 on the severity of vaginal dryness associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2
Secondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)Baseline and Week 2Change from Baseline to Week 2 on the severity of vulvar and/or vaginal itching or irritation associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2
Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)Baseline and Week 2Change from Baseline to Week 2 in Vaginal Color as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Color: No atrophy (pink) = 0; Mild (lighter in color) = 1; Moderate(pale in color) = 2; Severe (transparent/no color or inflamed) = 3 Severity was assessed by the Investigator at Baseline and Week 2
Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)Baseline and Week 2Change from Baseline to Week 2 in Vaginal Epithelial Integrity as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Integrity: No atrophy (normal) = 0; Mild (vaginal surface bleeds with scraping) = 1; Moderate (vaginal surface bleeds with light contact) = 2; Severe (vaginal surface has petechiae before contact and bleeds with light contact) = 3 Severity was assessed by the Investigator at Baseline and Week 2
Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)Baseline and Week 2Change from Baseline to Week 2 in Vaginal Epithelial Surface Thickness as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Surface Thickness: No atrophy (rogation and elasticity of vault) = 0; Mild (poor rogation with some elasticity noted of vaginal vault) = 1; Moderate (smooth, some elasticity of vaginal vault) = 2; Severe \[smooth, no elasticity, constriction of the upper one third of vagina or loss of vaginal tone (cystocele and rectocele)\] = 3 Severity was assessed by the Investigator at Baseline and Week 2
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total ScoreBaseline and Week 12Change from Baseline to Week 12 in FSFI Total Score as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - ArousalBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Arousal) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - DesireBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Desire) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - LubricationBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Lubrication) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - OrgasmBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Orgasm) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - PainBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Pain) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - SatisfactionBaseline and Week 12Change from Baseline to Week 12 in FSFI Domain Score (Satisfaction) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.
Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)Baseline and Week 2Change from Baseline to Week 2 in Vaginal Secretions as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Secretions: No atrophy (normal clear secretions noted on vaginal walls) = 0; Mild (superficial coating of secretions, difficulty with speculum insertion) = 1; Moderate (scant not covering the entire vaginal vault, may need lubrication with speculum insertion to prevent pain) = 2; Severe (none, inflamed, ulceration noted, need lubrication with speculum insertion to prevent pain) = 3 Severity was assessed by the Investigator at Baseline and Week 2
Secondary Efficacy Endpoints - Vaginal Superficial CellsBaseline and Week 2• Change from Baseline to Week 2 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo
Secondary Efficacy Endpoints- Vaginal Superficial CellsBaseline and Week 6Change from Baseline to Week 6 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo
Secondary Efficacy Endpoints - Vaginal Parabasal CellsBaseline and Week 2Change from Baseline to Week 2 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo

Other

MeasureTime frameDescription
PK Substudy - Hormone Concentration Assessments (Serum Estradiol, Estrone and Estrone Conjugates; SHBG)Pre-treatment, Day 2, Weeks 2 and 12Blood samples will be obtained from a subset of subjects at pre-selected sites to characterize PK parameters (AUC, tmax, Cmin, Cmax, Cavg) and to measure SHBG

Countries

Canada, United States

Participant flow

Participants by arm

ArmCount
Estradiol 4mcg Vaginal Softgel Capsule
Estradiol 4mcg Vaginal Softgel Capsule Estradiol
191
Estradiol 10mcg Vaginal Softgel Capsule
Estradiol 10mcg Vaginal Softgel Capsule Estradiol
191
Estradiol 25mcg Vaginal Softgel Capsule
Estradiol 25mcg Vaginal Softgel Capsule Estradiol
190
Placebo Vaginal Softgel Capsule
Placebo Vaginal Softgel Capsule Placebo
192
Total764

Baseline characteristics

CharacteristicEstradiol 4mcg Vaginal Softgel CapsuleEstradiol 10mcg Vaginal Softgel CapsuleEstradiol 25mcg Vaginal Softgel CapsulePlacebo Vaginal Softgel CapsuleTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
43 Participants29 Participants34 Participants41 Participants147 Participants
Age, Categorical
Between 18 and 65 years
148 Participants162 Participants156 Participants151 Participants617 Participants
Age, Continuous59.8 years
STANDARD_DEVIATION 5.9
58.5 years
STANDARD_DEVIATION 6.29
58.9 years
STANDARD_DEVIATION 6.26
59.3 years
STANDARD_DEVIATION 6.07
59.1 years
STANDARD_DEVIATION 6.14
BMI26.5 kg/m^2
STANDARD_DEVIATION 4.87
26.8 kg/m^2
STANDARD_DEVIATION 4.68
26.7 kg/m^2
STANDARD_DEVIATION 4.79
26.7 kg/m^2
STANDARD_DEVIATION 4.59
26.7 kg/m^2
STANDARD_DEVIATION 4.73
Height162.7 centimeters
STANDARD_DEVIATION 6.86
162.9 centimeters
STANDARD_DEVIATION 6.93
162.3 centimeters
STANDARD_DEVIATION 6.37
162.2 centimeters
STANDARD_DEVIATION 6.3
162.5 centimeters
STANDARD_DEVIATION 6.62
Region of Enrollment
Canada
13 participants10 participants15 participants12 participants50 participants
Region of Enrollment
United States
178 participants181 participants175 participants180 participants714 participants
Sex: Female, Male
Female
191 Participants191 Participants190 Participants192 Participants764 Participants
Sex: Female, Male
Male
0 Participants0 Participants0 Participants0 Participants0 Participants
Weight70.4 kilograms
STANDARD_DEVIATION 14.26
71.1 kilograms
STANDARD_DEVIATION 13.49
70.6 kilograms
STANDARD_DEVIATION 13.7
70.4 kilograms
STANDARD_DEVIATION 13.6
70.6 kilograms
STANDARD_DEVIATION 13.74

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —
other
Total, other adverse events
46 / 19141 / 19145 / 19066 / 192
serious
Total, serious adverse events
0 / 1913 / 1914 / 1901 / 192

Outcome results

Primary

Co-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)

• Change from Baseline to Week 12 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)-1.52 units on a scaleStandard Error 0.071
Estradiol 10mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)-1.69 units on a scaleStandard Error 0.071
Estradiol 25mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)-1.69 units on a scaleStandard Error 0.071
PlaceboCo-Primary Efficacy Endpoint - Severity of Most Bothersome Symptom (Dyspareunia)-1.28 units on a scaleStandard Error 0.07
p-value: 0.0149Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Primary

Co-Primary Efficacy Endpoint - Vaginal Parabasal Cells

• Change from Baseline to Week 12 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and 12 Weeks

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Parabasal Cells-40.63 percentage of vaginal parabasal cellsStandard Error 1.755
Estradiol 10mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Parabasal Cells-44.07 percentage of vaginal parabasal cellsStandard Error 1.751
Estradiol 25mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Parabasal Cells-45.55 percentage of vaginal parabasal cellsStandard Error 1.745
PlaceboCo-Primary Efficacy Endpoint - Vaginal Parabasal Cells-6.73 percentage of vaginal parabasal cellsStandard Error 1.75
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Primary

Co-Primary Efficacy Endpoint - Vaginal pH

• Change from Baseline to Week 12 in vaginal pH as compared to placebo

Time frame: Baseline and 12 Weeks

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal pH-1.32 pH unitsStandard Error 0.066
Estradiol 10mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal pH-1.42 pH unitsStandard Error 0.066
Estradiol 25mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal pH-1.34 pH unitsStandard Error 0.066
PlaceboCo-Primary Efficacy Endpoint - Vaginal pH-0.28 pH unitsStandard Error 0.066
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Primary

Co-Primary Efficacy Endpoint - Vaginal Superficial Cells

• Change from Baseline to Week 12 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and 12 Weeks

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Superficial Cells17.50 percentage of vaginal superficial cellsStandard Error 1.542
Estradiol 10mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Superficial Cells16.72 percentage of vaginal superficial cellsStandard Error 1.54
Estradiol 25mcg Vaginal Softgel CapsuleCo-Primary Efficacy Endpoint - Vaginal Superficial Cells23.20 percentage of vaginal superficial cellsStandard Error 1.529
PlaceboCo-Primary Efficacy Endpoint - Vaginal Superficial Cells5.63 percentage of vaginal superficial cellsStandard Error 1.537
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Arousal

Change from Baseline to Week 12 in FSFI Domain Score (Arousal) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Arousal0.875 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Arousal1.287 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Arousal1.392 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Arousal0.93 units on a scale
p-value: 0.9719ANCOVA
p-value: 0.0614ANCOVA
p-value: 0.0085ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Desire

Change from Baseline to Week 12 in FSFI Domain Score (Desire) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Desire0.625 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Desire0.800 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Desire0.848 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Desire0.630 units on a scale
p-value: 0.9999ANCOVA
p-value: 0.2855ANCOVA
p-value: 0.1189ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Lubrication

Change from Baseline to Week 12 in FSFI Domain Score (Lubrication) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Lubrication1.834 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Lubrication2.242 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Lubrication2.299 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Lubrication1.595 units on a scale
p-value: 0.4162ANCOVA
p-value: 0.0013ANCOVA
p-value: 0.0003ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Orgasm

Change from Baseline to Week 12 in FSFI Domain Score (Orgasm) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Orgasm1.162 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Orgasm1.274 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Orgasm1.591 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Orgasm1.202 units on a scale
p-value: 0.9929ANCOVA
p-value: 0.9634ANCOVA
p-value: 0.0898ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Pain

Change from Baseline to Week 12 in FSFI Domain Score (Pain) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Pain2.173 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Pain2.548 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Pain2.514 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Pain1.930 units on a scale
p-value: 0.5146ANCOVA
p-value: 0.0099ANCOVA
p-value: 0.015ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Satisfaction

Change from Baseline to Week 12 in FSFI Domain Score (Satisfaction) as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Satisfaction1.257 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Satisfaction1.384 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Satisfaction1.629 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) Domain Score - Satisfaction1.174 units on a scale
p-value: 0.9039ANCOVA
p-value: 0.3751ANCOVA
p-value: 0.0073ANCOVA
Secondary

Secondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total Score

Change from Baseline to Week 12 in FSFI Total Score as compared to placebo The FSFI is a brief, multidimensional questionnaire for assessing sexual function in women (Rosen et al., 2000). The questionnaire consists of 19 items that assess sexual function over the past 4 weeks and yield domain scores in six areas: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI questionnaire has a minimum total score of 2.0, a maximum score of 36.0 points and was administered at Baseline and Week 12.

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total Score7.909 units on a scale
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total Score9.431 units on a scale
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total Score10.283 units on a scale
PlaceboSecondary Efficacy Endpoints - Female Sexual Function Index (FSFI) - Total Score7.458 units on a scale
p-value: 0.9075ANCOVA
p-value: 0.0492ANCOVA
p-value: 0.0019ANCOVA
Secondary

Secondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)

Change from Baseline to Week 6 on the severity of vulvar and/or vaginal itching or irritation associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.57 units on a scaleStandard Error 0.055
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.64 units on a scaleStandard Error 0.055
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.61 units on a scaleStandard Error 0.055
PlaceboSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.55 units on a scaleStandard Error 0.055
p-value: 0.7829Mixed Models Analysis
p-value: 0.2328Mixed Models Analysis
p-value: 0.4118Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)

Change from Baseline to Week 12 on the severity of vulvar and/or vaginal itching or irritation associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.75 units on a scaleStandard Error 0.055
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.81 units on a scaleStandard Error 0.055
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.77 units on a scaleStandard Error 0.055
PlaceboSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.60 units on a scaleStandard Error 0.055
p-value: 0.0503Mixed Models Analysis
p-value: 0.0055Mixed Models Analysis
p-value: 0.0263Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)

Change from Baseline to Week 2 on the severity of vulvar and/or vaginal itching or irritation associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.47 units on a scaleStandard Error 0.054
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.56 units on a scaleStandard Error 0.053
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.51 units on a scaleStandard Error 0.054
PlaceboSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.47 units on a scaleStandard Error 0.054
p-value: 0.9616Mixed Models Analysis
p-value: 0.2439Mixed Models Analysis
p-value: 0.6518Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)

Change from Baseline to Week 8 on the severity of vulvar and/or vaginal itching or irritation associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.74 units on a scaleStandard Error 0.056
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.76 units on a scaleStandard Error 0.056
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.73 units on a scaleStandard Error 0.056
PlaceboSecondary Efficacy Endpoints - Other VVA Symptoms (Vulvar and/or Vaginal Itching or Irritation)-0.59 units on a scaleStandard Error 0.056
p-value: 0.0639Mixed Models Analysis
p-value: 0.0356Mixed Models Analysis
p-value: 0.0914Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)

Change from Baseline to Week 8 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.52 units on a scaleStandard Error 0.073
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.64 units on a scaleStandard Error 0.074
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.62 units on a scaleStandard Error 0.075
PlaceboSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.15 units on a scaleStandard Error 0.072
p-value: 0.0003Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)

Change from Baseline to Week 2 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-0.99 units on a scaleStandard Error 0.072
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.08 units on a scaleStandard Error 0.072
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.02 units on a scaleStandard Error 0.073
PlaceboSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-0.76 units on a scaleStandard Error 0.072
p-value: 0.026Mixed Models Analysis
p-value: 0.0019Mixed Models Analysis
p-value: 0.0105Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)

Change from Baseline to Week 6 on the severity of the MBS of dyspareunia (vaginal pain associated with sexual activity) associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.30 units on a scaleStandard Error 0.072
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.37 units on a scaleStandard Error 0.072
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.48 units on a scaleStandard Error 0.072
PlaceboSecondary Efficacy Endpoints - Severity of Most Bothersome Symptom (Dyspareunia)-1.03 units on a scaleStandard Error 0.07
p-value: 0.0069Mixed Models Analysis
p-value: 0.0009Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)

Change from Baseline to Week 12 on the severity of vaginal dryness associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.27 units on a scaleStandard Error 0.068
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.47 units on a scaleStandard Error 0.067
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.47 units on a scaleStandard Error 0.067
PlaceboSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-0.97 units on a scaleStandard Error 0.067
p-value: 0.0014Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)

Change from Baseline to Week 8 on the severity of vaginal dryness associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.25 units on a scaleStandard Error 0.069
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.44 units on a scaleStandard Error 0.068
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.34 units on a scaleStandard Error 0.068
PlaceboSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.01 units on a scaleStandard Error 0.068
p-value: 0.0128Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: 0.0008Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)

Change from Baseline to Week 2 on the severity of vaginal dryness associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-0.86 units on a scaleStandard Error 0.066
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.01 units on a scaleStandard Error 0.065
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-0.96 units on a scaleStandard Error 0.066
PlaceboSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-0.72 units on a scaleStandard Error 0.066
p-value: 0.1269Mixed Models Analysis
p-value: 0.0019Mixed Models Analysis
p-value: 0.0082Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)

Change from Baseline to Week 6 on the severity of vaginal dryness associated with VVA as compared to placebo VVA Symptoms Self-Assessment Questionnaire Severity Scale: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe. Subjects assessed severity at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.14 units on a scaleStandard Error 0.067
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.27 units on a scaleStandard Error 0.068
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-1.23 units on a scaleStandard Error 0.067
PlaceboSecondary Efficacy Endpoints - Severity of Other VVA Symptoms (Vaginal Dryness)-0.90 units on a scaleStandard Error 0.067
p-value: 0.0094Mixed Models Analysis
p-value: 0.0001Mixed Models Analysis
p-value: 0.0005Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)

Change from Baseline to Week 6 in Vaginal Color as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Color: No atrophy (pink) = 0; Mild (lighter in color) = 1; Moderate(pale in color) = 2; Severe (transparent/no color or inflamed) = 3 Severity was assessed by the Investigator at Baseline and Week 6

Time frame: Baseline to Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.82 units on a scaleStandard Error 0.049
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.93 units on a scaleStandard Error 0.049
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.89 units on a scaleStandard Error 0.049
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.50 units on a scaleStandard Error 0.048
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)

Change from Baseline to Week 12 in Vaginal Color as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Color: No atrophy (pink) = 0; Mild (lighter in color) = 1; Moderate(pale in color) = 2; Severe (transparent/no color or inflamed) = 3 Severity was assessed by the Investigator at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.97 units on a scaleStandard Error 0.049
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-1.06 units on a scaleStandard Error 0.049
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.96 units on a scaleStandard Error 0.049
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.60 units on a scaleStandard Error 0.049
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)

Change from Baseline to Week 2 in Vaginal Color as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Color: No atrophy (pink) = 0; Mild (lighter in color) = 1; Moderate(pale in color) = 2; Severe (transparent/no color or inflamed) = 3 Severity was assessed by the Investigator at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.69 units on a scaleStandard Error 0.048
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.77 units on a scaleStandard Error 0.047
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.78 units on a scaleStandard Error 0.048
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.40 units on a scaleStandard Error 0.047
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)

Change from Baseline to Week 8 in Vaginal Color as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Color: No atrophy (pink) = 0; Mild (lighter in color) = 1; Moderate(pale in color) = 2; Severe (transparent/no color or inflamed) = 3 Severity was assessed by the Investigator at Baseline and Week 8

Time frame: Baseline to Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.98 units on a scaleStandard Error 0.05
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-1.04 units on a scaleStandard Error 0.05
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.99 units on a scaleStandard Error 0.049
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Color)-0.50 units on a scaleStandard Error 0.049
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)

Change from Baseline to Week 6 in Vaginal Epithelial Integrity as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Integrity: No atrophy (normal) = 0; Mild (vaginal surface bleeds with scraping) = 1; Moderate (vaginal surface bleeds with light contact) = 2; Severe (vaginal surface has petechiae before contact and bleeds with light contact) = 3 Severity was assessed by the Investigator at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.97 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.02 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.01 units on a scaleStandard Error 0.051
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.61 units on a scaleStandard Error 0.05
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)

Change from Baseline to Week 12 in Vaginal Epithelial Integrity as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Integrity: No atrophy (normal) = 0; Mild (vaginal surface bleeds with scraping) = 1; Moderate (vaginal surface bleeds with light contact) = 2; Severe (vaginal surface has petechiae before contact and bleeds with light contact) = 3 Severity was assessed by the Investigator at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.97 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.07 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.01 units on a scaleStandard Error 0.05
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.60 units on a scaleStandard Error 0.05
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)

Change from Baseline to Week 2 in Vaginal Epithelial Integrity as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Integrity: No atrophy (normal) = 0; Mild (vaginal surface bleeds with scraping) = 1; Moderate (vaginal surface bleeds with light contact) = 2; Severe (vaginal surface has petechiae before contact and bleeds with light contact) = 3 Severity was assessed by the Investigator at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.85 units on a scaleStandard Error 0.049
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.87 units on a scaleStandard Error 0.049
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.93 units on a scaleStandard Error 0.049
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.53 units on a scaleStandard Error 0.049
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)

Change from Baseline to Week 8 in Vaginal Epithelial Integrity as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Integrity: No atrophy (normal) = 0; Mild (vaginal surface bleeds with scraping) = 1; Moderate (vaginal surface bleeds with light contact) = 2; Severe (vaginal surface has petechiae before contact and bleeds with light contact) = 3 Severity was assessed by the Investigator at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.03 units on a scaleStandard Error 0.052
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.08 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-1.08 units on a scaleStandard Error 0.051
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Integrity)-0.66 units on a scaleStandard Error 0.051
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)

Change from Baseline to Week 12 in Vaginal Epithelial Surface Thickness as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Surface Thickness: No atrophy (rogation and elasticity of vault) = 0; Mild (poor rogation with some elasticity noted of vaginal vault) = 1; Moderate (smooth, some elasticity of vaginal vault) = 2; Severe \[smooth, no elasticity, constriction of the upper one third of vagina or loss of vaginal tone (cystocele and rectocele)\] = 3 Severity was assessed by the Investigator at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.98 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-1.03 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.94 units on a scaleStandard Error 0.05
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.61 units on a scaleStandard Error 0.05
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)

Change from Baseline to Week 2 in Vaginal Epithelial Surface Thickness as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Surface Thickness: No atrophy (rogation and elasticity of vault) = 0; Mild (poor rogation with some elasticity noted of vaginal vault) = 1; Moderate (smooth, some elasticity of vaginal vault) = 2; Severe \[smooth, no elasticity, constriction of the upper one third of vagina or loss of vaginal tone (cystocele and rectocele)\] = 3 Severity was assessed by the Investigator at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.76 units on a scaleStandard Error 0.049
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.76 units on a scaleStandard Error 0.049
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.76 units on a scaleStandard Error 0.049
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.40 units on a scaleStandard Error 0.049
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)

Change from Baseline to Week 6 in Vaginal Epithelial Surface Thickness as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Surface Thickness: No atrophy (rogation and elasticity of vault) = 0; Mild (poor rogation with some elasticity noted of vaginal vault) = 1; Moderate (smooth, some elasticity of vaginal vault) = 2; Severe \[smooth, no elasticity, constriction of the upper one third of vagina or loss of vaginal tone (cystocele and rectocele)\] = 3 Severity was assessed by the Investigator at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.85 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.93 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.90 units on a scaleStandard Error 0.05
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.53 units on a scaleStandard Error 0.05
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)

Change from Baseline to Week 8 in Vaginal Epithelial Surface Thickness as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Epithelial Surface Thickness: No atrophy (rogation and elasticity of vault) = 0; Mild (poor rogation with some elasticity noted of vaginal vault) = 1; Moderate (smooth, some elasticity of vaginal vault) = 2; Severe \[smooth, no elasticity, constriction of the upper one third of vagina or loss of vaginal tone (cystocele and rectocele)\] = 3 Severity was assessed by the Investigator at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.96 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-1.04 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.99 units on a scaleStandard Error 0.051
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Epithelial Surface Thickness)-0.59 units on a scaleStandard Error 0.051
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)

Change from Baseline to Week 8 in Vaginal Secretions as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Secretions: No atrophy (normal clear secretions noted on vaginal walls) = 0; Mild (superficial coating of secretions, difficulty with speculum insertion) = 1; Moderate (scant not covering the entire vaginal vault, may need lubrication with speculum insertion to prevent pain) = 2; Severe (none, inflamed, ulceration noted, need lubrication with speculum insertion to prevent pain\] = 3 Severity was assessed by the Investigator at Baseline and Week 8

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.00 units on a scaleStandard Error 0.052
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.04 units on a scaleStandard Error 0.052
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.06 units on a scaleStandard Error 0.052
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.63 units on a scaleStandard Error 0.052
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)

Change from Baseline to Week 12 in Vaginal Secretions as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Secretions: No atrophy (normal clear secretions noted on vaginal walls) = 0; Mild (superficial coating of secretions, difficulty with speculum insertion) = 1; Moderate (scant not covering the entire vaginal vault, may need lubrication with speculum insertion to prevent pain) = 2; Severe (none, inflamed, ulceration noted, need lubrication with speculum insertion to prevent pain\] = 3 Severity was assessed by the Investigator at Baseline and Week 12

Time frame: Baseline and Week 12

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 12 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.01 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.06 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-1.04 units on a scaleStandard Error 0.051
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.64 units on a scaleStandard Error 0.051
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)

Change from Baseline to Week 2 in Vaginal Secretions as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Secretions: No atrophy (normal clear secretions noted on vaginal walls) = 0; Mild (superficial coating of secretions, difficulty with speculum insertion) = 1; Moderate (scant not covering the entire vaginal vault, may need lubrication with speculum insertion to prevent pain) = 2; Severe (none, inflamed, ulceration noted, need lubrication with speculum insertion to prevent pain) = 3 Severity was assessed by the Investigator at Baseline and Week 2

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.79 units on a scaleStandard Error 0.05
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.83 units on a scaleStandard Error 0.05
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.86 units on a scaleStandard Error 0.05
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.54 units on a scaleStandard Error 0.05
p-value: 0.0004Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)

Change from Baseline to Week 6 in Vaginal Secretions as compared to placebo Vaginal Mucosa Assessment Scale - Vaginal Secretions: No atrophy (normal clear secretions noted on vaginal walls) = 0; Mild (superficial coating of secretions, difficulty with speculum insertion) = 1; Moderate (scant not covering the entire vaginal vault, may need lubrication with speculum insertion to prevent pain) = 2; Severe (none, inflamed, ulceration noted, need lubrication with speculum insertion to prevent pain\] = 3 Severity was assessed by the Investigator at Baseline and Week 6

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.90 units on a scaleStandard Error 0.051
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.95 units on a scaleStandard Error 0.051
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.97 units on a scaleStandard Error 0.051
PlaceboSecondary Efficacy Endpoints - Vaginal Mucosa Assessment (Vaginal Secretions)-0.60 units on a scaleStandard Error 0.051
p-value: 0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Parabasal Cells

Change from Baseline to Week 2 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-40.23 percentage of vaginal parabasal cellsStandard Error 1.72
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-44.42 percentage of vaginal parabasal cellsStandard Error 1.71
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-45.60 percentage of vaginal parabasal cellsStandard Error 1.723
PlaceboSecondary Efficacy Endpoints - Vaginal Parabasal Cells-7.00 percentage of vaginal parabasal cellsStandard Error 1.72
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Parabasal Cells

Change from Baseline to Week 8 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-41.87 percentage of vaginal parabasal cellsStandard Error 1.768
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-43.78 percentage of vaginal parabasal cellsStandard Error 1.764
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-45.08 percentage of vaginal parabasal cellsStandard Error 1.762
PlaceboSecondary Efficacy Endpoints - Vaginal Parabasal Cells-7.86 percentage of vaginal parabasal cellsStandard Error 1.76
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Parabasal Cells

Change from Baseline to Week 6 in the percentage of vaginal parabasal cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-39.36 percentage of vaginal parabasal cellsStandard Error 1.75
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-43.55 percentage of vaginal parabasal cellsStandard Error 1.752
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Parabasal Cells-45.61 percentage of vaginal parabasal cellsStandard Error 1.746
PlaceboSecondary Efficacy Endpoints - Vaginal Parabasal Cells-9.23 percentage of vaginal parabasal cellsStandard Error 1.741
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal pH

Change from Baseline to Week 6 in vaginal pH as compared to placebo

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.32 pH unitsStandard Error 0.066
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.40 pH unitsStandard Error 0.066
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.48 pH unitsStandard Error 0.066
PlaceboSecondary Efficacy Endpoints - Vaginal pH-0.30 pH unitsStandard Error 0.065
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal pH

Change from Baseline to Week 8 in vaginal pH as compared to placebo

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.35 pH unitsStandard Error 0.067
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.46 pH unitsStandard Error 0.067
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.45 pH unitsStandard Error 0.066
PlaceboSecondary Efficacy Endpoints - Vaginal pH-0.38 pH unitsStandard Error 0.066
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal pH

Change from Baseline to Week 2 in vaginal pH as compared to placebo

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.23 pH unitsStandard Error 0.064
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.37 pH unitsStandard Error 0.064
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal pH-1.30 pH unitsStandard Error 0.065
PlaceboSecondary Efficacy Endpoints - Vaginal pH-0.28 pH unitsStandard Error 0.064
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Superficial Cells

• Change from Baseline to Week 2 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 2

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 2 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells31.35 percentage of vaginal superficial cellsStandard Error 1.496
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells31.93 percentage of vaginal superficial cellsStandard Error 1.488
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells38.85 percentage of vaginal superficial cellsStandard Error 1.5
PlaceboSecondary Efficacy Endpoints - Vaginal Superficial Cells6.05 percentage of vaginal superficial cellsStandard Error 1.498
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints - Vaginal Superficial Cells

Change from Baseline to Week 8 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 8

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 8 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells19.04 percentage of vaginal superficial cellsStandard Error 1.561
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells17.41 percentage of vaginal superficial cellsStandard Error 1.558
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints - Vaginal Superficial Cells23.88 percentage of vaginal superficial cellsStandard Error 1.554
PlaceboSecondary Efficacy Endpoints - Vaginal Superficial Cells5.98 percentage of vaginal superficial cellsStandard Error 1.551
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Secondary

Secondary Efficacy Endpoints- Vaginal Superficial Cells

Change from Baseline to Week 6 in the percentage of vaginal superficial cells (by vaginal cytologic smear) compared to placebo

Time frame: Baseline and Week 6

Population: For the statistical test utilized (MMRM), the number of subjects analyzed varied based on if they had both Baseline and Week 6 data so it would not necessarily match the overall number of subjects in the MITT Population at Baseline.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Estradiol 4mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints- Vaginal Superficial Cells18.41 percentage of vaginal superficial cellsStandard Error 1.536
Estradiol 10mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints- Vaginal Superficial Cells16.88 percentage of vaginal superficial cellsStandard Error 1.543
Estradiol 25mcg Vaginal Softgel CapsuleSecondary Efficacy Endpoints- Vaginal Superficial Cells22.65 percentage of vaginal superficial cellsStandard Error 1.532
PlaceboSecondary Efficacy Endpoints- Vaginal Superficial Cells5.43 percentage of vaginal superficial cellsStandard Error 1.525
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
p-value: <0.0001Mixed Models Analysis
Other Pre-specified

PK Substudy - Hormone Concentration Assessments (Serum Estradiol, Estrone and Estrone Conjugates; SHBG)

Blood samples will be obtained from a subset of subjects at pre-selected sites to characterize PK parameters (AUC, tmax, Cmin, Cmax, Cavg) and to measure SHBG

Time frame: Pre-treatment, Day 2, Weeks 2 and 12

Source: ClinicalTrials.gov · Data processed: Mar 10, 2026