Vaginal estrogen therapy safe for postmenopausal symptoms

USA: The low-dose vaginal estrogen therapy remains underused, despite its proven effectiveness for the treatment of genital symptoms of menopause. This is contributed largely to misconceptions regarding its safety. However, a new study published in the journal Menopause has found that its use is not associated with a higher risk of cancer or cardiovascular disease.

About 25% to 70% of the postmenopausal women face urinary and genital issues collectively known as the genitourinary syndrome of menopause (GSM). The symptoms include lack of lubrication, pain during intercourse, urinary tract infections, vaginal burning, and irritation. GSM symptoms do not resolve over time, are chronic, and can become progressively worse without treatment.

Low-dose vaginal estrogen therapy is the recommended and most effective treatment for GSM. Multiple studies document the superior effectiveness of vaginal estrogen over nonhormone therapies and demonstrate that it provides better symptom relief than oral estrogen therapy.

Owing to its misconceptions regarding its safety (which partially stem from the FDA-issued black-box warning that relates to systemic hormone therapy), vaginal estrogen therapy is not prescribed as often as it could be, leading to lower quality of life in many postmenopausal women.

Shilpa N. Bhupathiraju, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, and colleagues followed women from the Nurses' Health Study for more than 18 years to examine the associations between the use of vaginal estrogen and multiple health outcomes including cancer (total invasive, breast, endometrial, ovarian, and colorectal cancer), cardiovascular disease (total myocardial infarction, stroke, and pulmonary embolism/deep vein thrombosis), and hip fracture.

"Over-the-counter vaginal lubricants and moisturizers are often used as first-line treatments for women with symptoms of GSM," says Dr. JoAnn Pinkerton, NAMS executive director. "Persistent symptoms often need therapies such as local vaginal estrogen, intravaginal dehydroepiandrosterone, or oral ospemifene. This study adds to a growing body of data showing the long-term efficacy and safety of low-dose vaginal estrogen, which works primarily locally with minimal systemic absorption."

"Vaginal estrogen use was not associated with a higher risk of cardiovascular disease or cancer. Our findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause," concluded the authors.