Vaginal estrogen tablets are not associated with an increased risk of recurrent ischemic stroke for postmenopausal women, according to results of a study published in Stroke. Currently, systemic estrogen replacement therapy is contraindicated for women who have a history of ischemic stroke due to the risk of stroke recurrence, the study authors said.1
Currently, systemic estrogen replacement therapy is contraindicated for women who have a history of ischemic stroke due to the risk of stroke recurrence. | Image Credit: WindyNight – stock.adobe.com
“It is well known that taking systemic hormone replacement therapy, such as oral estrogen 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 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,” Kimia Ghias Haddadan, MD, affiliated with the department of cardiology at Copenhagen University Hospital – Herlev and Gentofte in Copenhagen, Denmark, said in a news release.2
There has been evidence showing that hormone therapy with estrogen alone or with progesterone increases a woman’s risk of stroke, especially for postmenopausal women. In a review published in Climacteric, the study authors state that the increased risk could be limited to ischemic stroke, and limited evidence shows that the absolute risk of stroke from standard-dose hormone therapy is rare, but it is considerably greater for older women.3
Therefore, the current study authors aimed to address the knowledge gap for vaginal estrogen use and increased risk of stroke for women who had a history of ischemic stroke. Data was from nationwide registries in Denmark and included women who experienced an ischemic stroke from January 1, 2008, to December 31, 2017. A total of 34,273 women were included in the study cohort, and 3353 women developed recurrent ischemic stroke during the follow-up period. Women who had another stroke were matched with women who did not.1
Patients in the stroke group had a lower prevalence of current vaginal estradiol tablet use at 1.9% compared with those who did not have another stroke at 3.2%, but the prevalence of high dose was similar at 0.8% and 1.5%, respectively. When compared with no use, investigators reported no significant association between current, recent, or past use of vaginal estradiol tablets and recurrent ischemic stroke. There was also no association between high- and low-dose estradiol tablets and recurrent stroke or total cumulative dose and recurrent ischemic stroke.1
“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. While the study did not find a statistically significant association with stroke recurrence, the findings should be interpreted with caution,” Samar R. El Khoudary, PhD, MPH, FAHA, a professor in the department of epidemiology at the University of Pittsburgh School of Public Health, said in the news release. “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.”
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