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Vaginal estrogens do not affect cancer, cardiovascular event risk

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August 17, 2017

Postmenopausal women who use vaginal estrogen are not at increased risk for cardiovascular events or cancer compared with those who do not use vaginal estrogen, suggesting the safety and efficacy of the therapy, according to findings published in Menopause.

Carolyn J. Crandall, MD, MS, of the department of medicine at the University of California, Los Angeles, and colleagues evaluated data from the Women’s Health Initiative observational study on 32,433 postmenopausal women without hysterectomy (3,003 users of vaginal estrogen during follow-up) and 14,133 postmenopausal women with hysterectomy (1,207 users of vaginal estrogen during follow-up). Researchers sought to determine the association between the use of estrogen and risk for a global index event, defined as time to first occurrence of coronary heart disease, invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer or death from any cause. Follow-up was a mean of 6.4 years. The mean age of participants who never used vaginal estrogen was 64.8 years, and mean age of participants who used vaginal estrogen during follow-up was 65.5 years.

The risk for invasive breast cancer, death, stroke, colorectal cancer and venous thromboembolism was similar between users and nonusers of vaginal estrogen after adjustment for age, education, past hormone therapy use, history of cancer, history of CVD, history of VTE, race/ethnicity, BMI, diabetes, physical activity level, hypertension, Gail model breast cancer risk score, previous fracture, smoking, household income and alcohol intake level.

The risk for CHD was 48% lower and the risk for hip fracture was 60% lower among users of vaginal estrogen compared with nonusers of vaginal estrogen; further, the risk for the global index event was lower among users compared with nonusers (adjusted HR = 0.76; 95% CI, 0.64-0.91).

In an analysis of participants divided by hysterectomy status, the risk for several outcomes was lower among users compared with nonusers for a global index event (aHR = 0.68; 95% CI, 0.55-0.86), death (aHR = 0.62; 95% CI, 0.41-0.93), CHD (aHR = 0.39; 95% CI, 0.19-0.78) and hip fracture (aHR = 0.4; 95% CI, 0.16-0.96).

“We did not observe an increased risk of cardiovascular disease or cancer among women using vaginal estrogen compared with nonusers,” the researchers wrote. “These findings should provide reassurance to women and their health providers regarding the safety of vaginal estrogen and will help to inform menopausal HT clinical decision-making.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.