Vaginal Estrogen Tablets Found Safe for Postmenopausal Women After Stroke

Recent research indicates that vaginal estrogen tablets are not linked to an increased risk of recurrent ischemic strokes among postmenopausal women with a history of stroke. The study, conducted in Denmark, analyzed prescription data from over 34,000 women aged 45 and older who experienced their first stroke and excluded those who were using vaginal estrogen prior to their initial event. Over a 10-year period, researchers compared rates of recurrent strokes between women using vaginal estrogen tablets and those who did not. The findings revealed no significant association between the use of vaginal estrogen and subsequent strokes, regardless of dosage or duration of use.

Vaginal estrogen is commonly prescribed to alleviate menopausal symptoms such as vaginal dryness and discomfort, as it is locally absorbed through the vaginal mucosa, resulting in limited systemic hormone exposure. This contrasted with oral or transdermal estrogen formulations, which carry higher risks for systemic side effects, including stroke. The study’s lead author, Dr. Kimia Ghias Haddadan, emphasized that while systemic hormone replacement therapy has been linked to increased stroke risk, vaginal estrogen appears to be safe for women with previous strokes.

The research was based on prescription and health registry data in Denmark, providing a comprehensive overview of real-world outcomes. The results suggest that vaginal estrogen could be a safe treatment option for menopausal women with a history of stroke, improving quality of life without elevating the risk of recurrence. However, the authors caution that this does not imply vaginal estrogen prevents strokes, but supports its safe use in this specific high-risk group.

These findings extend prior evidence from U.S. studies like the Women’s Health Initiative and Nurses’ Health Study, which found no increased risk of stroke with vaginal estrogen in healthy women. The study’s strengths include its large-scale, nationwide design, and its focus on a previously understudied high-risk population. Limitations include potential health differences among users and reliance on prescription records as a proxy for medication adherence.

Overall, the study offers reassurance to healthcare providers and women considering vaginal estrogen therapy after a stroke, especially for managing menopause-related symptoms. Future research may explore further safety and efficacy in diverse populations and different formulations of estrogen therapy.