Let's Reassure Women About the Safety of Vaginal Estrogen

Andrew M. Kaunitz, MD


January 17, 2019

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville.

Today I'd like to discuss the safety of vaginal estrogen. Genitourinary syndrome of menopause (GSM) is highly prevalent; has a negative impact on a woman's sexuality and quality of life; and in contrast with vasomotor symptoms, often progresses if not treated.[1]

Vaginal estrogen represents effective treatment for GSM.[1,2] In a recent Medscape commentary, I discussed the efficacy of vaginal estrogen in addressing GSM.

Notwithstanding the prevalence of GSM and the effectiveness of vaginal estrogen in managing this condition, relatively few women with bothersome symptoms from GSM use this class of medication. Concerns regarding the safety of vaginal estrogen contribute to its low use in US women.[3]

A recent report[4] from the Nurses' Health Study provides important new information regarding the safety of vaginal estrogen. In this large, long-term cohort study, the mean duration of vaginal estrogen use was almost 3 years.

The incidence of cardiovascular outcomes, including myocardial infarction, stroke, and venous thromboembolism, was similar in users and nonusers of vaginal estrogen.[4] Likewise, the risk for invasive cancer, including endometrial and breast cancer, was similar in users and nonusers.[4]

Current guidance from the American College of Obstetricians and Gynecologists[5] as well as the North American Menopause Society recommends that in appropriate candidates, low-dose vaginal estrogen can be used indefinitely without concomitant progestin therapy.[6] The findings of this important study support these recommendations.

Thank you for the honor or your time. I am Andrew Kaunitz.


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