Vaginal Estrogen Safe for Postmenopausal Stroke Survivors, Study Finds

A groundbreaking study published in Stroke, the journal of the American Stroke Association, has revealed that vaginal estrogen tablets do not increase the risk of recurrent ischemic stroke in postmenopausal women with a history of stroke. The research, conducted using Denmark's comprehensive health registry, analyzed data from over 34,000 women aged 45 and older who had experienced a first ischemic stroke. Unlike systemic hormone replacement therapies such as oral estrogen, which are known to elevate stroke risk, vaginal estrogen tablets dissolve locally and provide minimal systemic absorption, making them potentially safer for this vulnerable population.

Led by Dr. Kimia Ghias Haddadan of Copenhagen University Hospital, the study found no significant association between vaginal estrogen use and recurrent stroke, regardless of whether women were current, recent, or past users, or whether they used high or low doses. This research is particularly significant because it addresses a critical gap in knowledge regarding hormone therapy safety for women who have already suffered a stroke—a group often excluded from clinical trials. The findings were further validated by the study's large-scale, real-world design and careful adjustment for various health and demographic factors.

While the results are reassuring, researchers caution that the study does not suggest vaginal estrogen prevents strokes, but rather that it appears safe for managing menopausal symptoms like vaginal dryness in high-risk women. The American Heart Association's 2020 Statement on Menopause Transition and Cardiovascular Disease Risk emphasizes the importance of such research, though limitations include potential health biases among users and the focus solely on vaginal tablets rather than other estrogen formulations. Nonetheless, this study provides crucial evidence that could improve quality of life for postmenopausal stroke survivors without compromising their safety.