Los Angeles—Hot flashes might be the most commonly reported problem associated with menopause, but many women also suffer from sexual and urinary issues. Because of concerns about the safety of vaginal estrogen, women have not always been able to get the relief they need.
Now, a new study published in Menopause, the journal of The North American Menopause Society (NAMS), offers information that might increase the percentage of menopausal women who are comfortable treating those symptoms.
A study led by researchers from the Department of Medicine at the University of California at Los Angeles provides evidence that vaginal estrogen is not only effective, but also safe for the treatment of the genitourinary syndrome during menopause.
While earlier results from the Women’s Health Initiative (WHI) raised questions about the safety of hormone therapy—including higher risks of cancer and stroke—more recent studies have found that low-dose vaginal estrogen therapy is safer than systemic estrogen therapy.
Vaginal estrogen also is effective in treating those issues, although, study authors point out, it is not effective in managing hot flashes.
For the analysis, WHI data from more than 45,000 participants were analyzed. Results indicate that, in women with an intact uterus, the risk of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonary embolism were not significantly different between vaginal-estrogen users and nonusers. The adjusted hazard ratio was 0.68. Among women who had undergone hysterectomy, the risks were not significantly different in users versus nonusers of vaginal estrogen, for a hazard ratio of 0.94.
At the same time, women using vaginal estrogen were found to be at less risk for coronary heart disease, fracture, and all-cause mortality than nonusers.
Study authors point out that the type of low-dose vaginal estrogen doesn’t affect efficacy and safety, whether the formulation is a topical cream, an intravaginal insert, or an intravaginal ring.
“The risks of cardiovascular disease and cancer were not elevated among postmenopausal women using vaginal estrogens, providing reassurance about the safety of treatment.”
“These findings should reassure women and their healthcare providers that low-dose vaginal estrogen, which keeps blood levels within the normal postmenopausal range, is effective and safe for postmenopausal women who need relief from only vaginal symptoms,” added JoAnn Pinkerton, NAMS executive director. “The boxed warnings about the risk of heart disease, stroke, blood clots, and cancer do not apply to these low-dose vaginal therapies. Instead, women who experience bleeding or those with breast cancer should include their healthcare providers and oncologists in deciding about this option.”
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