Study offers reassurance about safety of vaginal oestrogen

By Jane Lewis
A large prospective study has found no link between vaginal oestrogen use for genitourinary syndrome of menopause (GSM) and increased risk of cardiovascular disease (CVD) or cancer.

This well conducted study ‘provides further evidence of the safety of vaginal oestrogen for the relief of symptoms of vulvovaginal atrophy [VVA] in postmenopausal women,’ commented Professor Rod Baber, Clinical Professor of Obstetrics and Gynaecology at The University of Sydney, and Past President of the International Menopause Society.

‘It is likely that many of the women in this study were using higher doses of vaginal oestrogens than are currently available in Australia, further confirming the safety of the lower dose preparations’, he added.

According to the study’s authors, despite strong data support­ing its effectiveness, vaginal oestrogen remained an underused treatment for GSM, due to perceived risks associated with menopausal hormone therapy.

In the study, published in the journal Menopause, postmeno­pausal women from the Nurses’ Health Study (1982­2012) who were not users of systemic hormone therapy were asked in biennial questionnaires to report on their use of vaginal oestrogen. During 18 years’ follow up, after accounting for a range of potential confounders, no significant increase in risk of any health outcome was observed with vaginal oestrogen use, including CVD (including myocardial infarction, stroke or pulmonary embolism), cancer (including total invasive cancer, invasive breast, ovarian, endometrial or colorectal cancer) or hip fracture.

‘These findings are broadly consistent with the findings of the Women’s Health Initiative [WHI] observational study and several Scandinavian studies,’ said Professor Baber. ‘They confirm that long­term use of vaginal oestrogen is safe and does not require added progestogen therapy for endometrial protection.’

He said it was telling that less than 3% of this study population were using vaginal oestrogens – less than the 10% of users in the WHI study and much less than the estimated 40% of women who experienced bothersome local urogenital symptoms following the menopause.

‘Given the safety profile of vaginal oestrogens and the prevalence of VVA, this study is a timely reminder to all of us that we should ask our patients about symptoms of VVA and offer this safe and effective intervention where appropriate’, Professor Baber advised.
Menopause 2018; doi: 10.1097/GME.0000000000001284.