Credit score: Pixabay/CC0 Public Area
Utilizing vaginal estrogen tablets was not related to an elevated threat of recurrent ischemic stroke amongst postmenopausal ladies in a registry in Denmark, in keeping with analysis printed in Stroke.
In contrast to oral estrogen or transdermal formulations akin to lotions and patches, the ladies on this registry-based examine had prescriptions for estrogen tablets designed for vaginal use. These tablets dissolve domestically, and the estrogen is absorbed by the vaginal mucosa to assist handle widespread menopausal signs, akin to vaginal dryness and discomfort throughout intercourse.
In wholesome ladies, this gentle improve in estrogen within the bloodstream from vaginal tablets does not appear to trigger issues. Nevertheless, it was beforehand unknown whether or not the vaginal estrogen tablets posed a threat to ladies with a historical past of stroke, a bunch thought of extra susceptible to recurrent strokes.
“It is well known that taking systemic hormone replacement therapy, such as oral estrogen tablets, may increase the risk of stroke after menopause,” mentioned the examine’s lead creator Kimia Ghias Haddadan, M.D., affiliated with the division of cardiology at Copenhagen College Hospital—Herlev and Gentofte in Copenhagen, Denmark.
“While other studies have not detected an increased risk of stroke associated with the use of vaginal estrogen in healthy postmenopausal women, there is no data on whether vaginal estrogen tablets pose an increased risk for women who have already had a stroke.”
This examine examined prescription knowledge for greater than 34,000 postmenopausal ladies, aged 45 and older, who had skilled a primary ischemic stroke in a nationwide registry in Denmark. Girls who used vaginal estrogen earlier than their first stroke have been excluded.
In the course of the 10-year examine, researchers in contrast the charges of recurrent stroke in ladies who used vaginal estrogen tablets with the charges of girls who didn’t use the vaginal therapy.
The evaluation discovered:
Using vaginal estrogen tablets was not related to an elevated threat of getting a second stroke in postmenopausal ladies with a earlier stroke.
When in comparison with not utilizing vaginal estrogen tablets, there was no vital affiliation amongst present use, current use or previous use of the vaginal estrogen tablets with a second stroke.
Equally, no elevated threat of a second stroke was discovered between high-dose present use or low-dose present use.
Even ladies with greater cumulative use of vaginal estrogen tablets didn’t have a better threat of a second stroke in comparison with 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 mentioned.
“U.S.-based research, such because the Girls’s Well being Initiative and the Nurses’ Well being Examine, have proven no elevated stroke threat with vaginal estrogen in wholesome ladies. Our examine extends this reassurance to ladies with a historical past of stroke.
“It is important to note that these findings suggest that vaginal estrogen is likely safe for this high-risk group of women who have already had a stroke; however, they do not imply that vaginal estrogen prevents strokes,” she mentioned.
Haddadan mentioned the findings needs to be relevant to postmenopausal ladies within the U.S. and different nations, particularly the place related vaginal estrogen merchandise are used.
The examine’s strengths embrace its massive, nationwide design, which supplied a complete view of real-world scientific outcomes in a high-risk inhabitants. Through the use of Danish registries, researchers may precisely monitor stroke diagnoses, prescriptions and related well being and demographic info throughout your complete inhabitants.
“As an epidemiologist, I see this study as a valuable contribution because it focuses on a population often excluded from hormone therapy research, midlife women with a prior stroke, and examines an increasingly used route of administration: vaginal tablets,” mentioned Samar R. El Khoudary, Ph.D., M.P.H., FAHA, chair of the American Coronary heart Affiliation’s 2020 Assertion on Menopause Transition and Cardiovascular Illness Danger: Implications for Timing of Early Prevention.
“While the study did not find a statistically significant association with stroke recurrence, the findings should be interpreted with caution. Real-world data can’t account for all clinical and behavioral factors, and prescription fill records don’t confirm whether the medication was actually used. Still, studies like this allow us to explore important questions that are often not feasible to address in clinical trials.”
El Khoudary, who was not concerned on this examine, is a professor within the division of epidemiology on the College of Pittsburgh Faculty of Public Well being.
The examine has a number of limitations. Girls who used vaginal estrogen may need been more healthy total, which may have an effect on the outcomes. Nevertheless, researchers adjusted for a spread of well being and demographic components, akin to drugs, medical circumstances, earnings and training, to scale back the impression of this challenge.
Estrogen use was decided from prescription data, which point out the remedy was allotted however not essentially taken as prescribed; subsequently, precise use or adherence can’t be confirmed. And the examine targeted solely on one type of therapy, vaginal estrogen tablets, as a result of it’s the most typical mode of therapy in Denmark.
The findings could not apply to different estrogen formulations, akin to vaginal lotions, patches or rings. Price can be not a difficulty, as a result of Denmark supplies free common well being care to all residents.
Examine particulars, background and design:
A nationwide examine utilizing well being data recognized 56,642 ladies who had skilled a stroke between January 1, 2008, and December 31, 2017.
A complete of 34,274 ladies aged 45 or older (median age of 75) have been included on this evaluation, whereas 22,368 ladies have been excluded for numerous causes. Exclusions included ladies underneath the age of 45, these with a historical past of vaginal estrogen use, and girls who had used systemic hormone remedy inside one yr earlier than their first stroke.
3,353 ladies who skilled a second stroke have been in comparison with an equal variety of ladies who didn’t expertise a second stroke.
Utilizing prescription knowledge, researchers assessed whether or not the ladies had used vaginal estrogen tablets and categorized their use as present (inside three months), current (three to 24 months) or previous (greater than 24 months earlier than the examine).
To judge whether or not vaginal estrogen use was linked to the danger of a second stroke in postmenopausal ladies, researchers in contrast every lady who’d had a second stroke (case group) with a girl of the identical age who didn’t (management group).
The examine didn’t embrace knowledge on race as a result of that info just isn’t collected about sufferers in Denmark.
“We hope our findings reassure health professionals caring for postmenopausal women with a history of stroke. For these women, especially those with troubling menopause symptoms, the study shows that this type of therapy may be a safe choice. It could improve their quality of life without raising the risk of another stroke,” Haddadan mentioned.
Extra info:
Recurrent Ischemic Stroke and Vaginal Estradiol in Girls With Prior Ischemic Stroke: A Nationwide Nested Case-Management Examine, Stroke (2025). DOI: 10.1161/STROKEAHA.125.050986
Offered by
American Coronary heart Affiliation
Quotation:
Vaginal estrogen tablets could also be protected for postmenopausal ladies who’ve had a stroke (2025, August 21)
retrieved 21 August 2025
from https://medicalxpress.com/information/2025-08-vaginal-estrogen-tablets-safe-postmenopausal.html
This doc is topic to copyright. Aside from any truthful dealing for the aim of personal examine or analysis, no
half could also be reproduced with out the written permission. The content material is supplied for info functions solely.
