Using vaginal oestrogen tablets was not associated with an increased risk of recurrent ischaemic stroke among postmenopausal women in a registry in Denmark, according to research published in 'Stroke', the peer-reviewed scientific journal of the American Stroke Association, a division of the American Heart Association.
Unlike oral oestrogen or transdermal formulations such as creams and patches, the women in this registry-based study had prescriptions for oestrogen tablets designed for vaginal use. These tablets dissolve locally, and the oestrogen is absorbed through the vaginal mucosa to help manage common menopausal symptoms, such as vaginal dryness and discomfort during intercourse. In healthy women, this mild increase in estrogen in the bloodstream from vaginal tablets doesn’t seem to cause problems. However, it was previously unknown whether the vaginal oestrogen tablets posed a risk to women with a history of stroke, a group considered more vulnerable to recurrent strokes.
“It is well known that taking systemic hormone replacement therapy, such as oral oestrogen tablets, may increase the risk of stroke after menopause. While other studies have not detected an increased risk of stroke associated with the use of vaginal oestrogen in healthy postmenopausal women, there is no data on whether vaginal oestrogen tablets pose an increased risk for women who have already had a stroke,” said the study’s lead author Kimia Ghias Haddadan, M.D., affiliated with the department of cardiology at Copenhagen University Hospital – Herlev and Gentofte in Copenhagen, Denmark.
This study examined prescription data for more than 34,000 postmenopausal women, aged 45 and older, who had experienced a first ischaemic stroke in a national registry in Denmark. Women who used vaginal oestrogen before their first stroke were excluded. During the 10-year study, researchers compared the rates of recurrent stroke in women who used vaginal oestrogen tablets with the rates of women who did not use the vaginal treatment.
The analysis found:
- The use of vaginal oestrogen tablets was not associated with an increased risk of having a second stroke in postmenopausal women with a previous stroke.
- When compared to not using vaginal oestrogen tablets, there was no significant association among current use, recent use or past use of the vaginal oestrogen tablets with a second stroke.
- Similarly, no increased risk of a second stroke was found between high-dose current use or low-dose current use.
- Even women with higher cumulative use of vaginal oestrogen tablets did not have a higher risk of a second stroke compared to non-users.
“We were cautiously hopeful about the findings, and it was reassuring to discover that the use of vaginal estrogen did not raise the risk of recurrent stroke in this high-risk population,” Haddadan said. “US-based studies, such as the Women’s Health Initiative and the Nurses’ Health Study, have shown no increased stroke risk with vaginal oestrogen in healthy women. Our study extends this reassurance to women with a history of stroke.
“It is important to note that these findings suggest that vaginal oestrogen is likely safe for this high-risk group of women who have already had a stroke; however, they do not imply that vaginal oestrogen prevents strokes,” she said.
View the full paper at: Recurrent Ischemic Stroke and Vaginal Estradiol in Women With Prior Ischemic Stroke: A Nationwide Nested Case-Control Study | Stroke
