Vaginal estrogen not associated with increased risks for CVD, cancer

[Healio, 12/19/18]   Postmenopausal women who reported use of vaginal estrogen were not at increased risks for developing cardiovascular disease, cancer or hip fracture over 18 years vs. similar women who did not report taking vaginal estrogen, according to an analysis of the Nurses’ Health Study.

Unlike oral estrogen therapy, vaginal estrogen to treat genitourinary syndrome of menopause is not subject to gastrointestinal conversion of estradiol to estrone, avoiding the first-pass liver metabolism that has been associated with increased risk for thrombosis, JoAnn E. Manson, MD, DrPH, FACE, chief of the division of preventive medicine at Brigham and Women’s Hospital, and professor of medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School, and colleagues wrote in the study background.

“Despite the availability of strong and generally consistent data to show its effectiveness, low-dose vaginal estrogen therapy remains underutilized owing to perceived risks associated with menopausal hormone therapy,” Manson and colleagues wrote. “In addition, the FDA-issued black box warning on the low-dose vaginal estrogen package label discourages clinicians from prescribing the product and women from using prescribed therapy.”

Manson and colleagues analyzed data from 53,797 postmenopausal women participating in the Nurses’ Health Study (1982-2012) who were not current users of systemic HT at baseline or during 18 years of follow-up. Participants self-reported vaginal estrogen use on biennial questionnaires (n = 896), and incident health outcomes were assessed via self-report and medical records. Researchers used Cox proportional hazard models to estimate risks for any cancer, CV outcomes (total myocardial infarction, stroke and pulmonary embolism/deep vein thrombosis) and hip fracture with vaginal estrogen use…………………..

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