Vaginal estrogen therapy safe for postmenopausal symptoms

The low dose vaginal estrogen therapy remains underused, despite its proven effectiveness for the treatment of genital symptoms of menopause. This is contributed largely to misconceptions regarding its safety. However, a new study published has found that its use is not associated with a higher risk of cancer or cardiovascular disease.

About 25-70% of the postmenopausal women face urinary and genital issues collectively known as the genitourinary syndrome of menopause (GSM). The symptoms include lack of lubrication, pain during intercourse, urinary tract infections, vaginal burning, and irritation. GSM symptoms do not resolve over time, are chronic and can become progressively worse without treatment.

Low-dose vaginal estrogen therapy is the recommended and most effective treatment for GSM. Multiple studies document the superior effectiveness of vaginal estrogen over non-hormone therapies and demonstrate that it provides better symptom relief than oral estrogen therapy.

Owing to misconceptions regarding its safety ( which partially stem from the FDA-issued black-box warning that relates to systemic hormone therapy), vaginal estrogen therapy is not prescribed as often as it could be, leading to lower quality of life in many postmenopausal women.

Researchers followed women for more than 18 years to examine the associations between the use of vaginal estrogen and multiple health outcomes including cancer ( total invasive, breast, endometrial, ovarian and colorectal cancer), cardiovascular disease ( total myocardial infarction, stroke and pulmonary embolism/ deep vein thrombosis ) and hip fracture.

Over-the-counter vaginal lubricants and moisturisers are often used as first-line treatments for women with symptoms of GSM, says a Dr. " Persistent symptoms often need therapies such as local vaginal estrogen, intra-vaginal dehydroepiandrosterone, or oral ospemifent. This study adds to a growing body of data showing the long-term efficacy and safety of low-dose vaginal estrogen, which works primarily locally with minimal systemic absorption".

" Vaginal estrogen use was not associated with a higher risk of cardiovascular disease or cancer. Our findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause, " concluded the authors.

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Alcohol may cause muscle loss in post-menopausal women

Post-menopausal women who indulge in heavy alcohol consumption may be at a higher risk of developing sarcopenia — the loss of muscle mass and strength — which may lead to cardio-metabolic diseases and disabilities, researchers say.

Sarcopenia is an age-related process that also affects balance, gait, and overall ability to perform tasks of daily living.

High-risk alcohol drinking — known to inhibit skeletal muscle protein synthesis — is also closely related to diabetes, hypertension and dyslipidemia, which are modifiable risk factors for sarcopenia.

The findings showed that the prevalence of sarcopenia is nearly four times higher in the high-risk alcohol-drinking group as compared to the low-risk group.

Further, the women in the high-risk group were also more likely to have worse blood pressure and total cholesterol levels.

“With this study suggesting that more muscle loss leads to sarcopenia and other studies suggesting that even one drink of alcohol may increase the risk of breast cancer, postmenopausal women should limit their alcohol intake,” said a Dr.

To prevent the loss of muscle mass and increase strength, pre-clinical studies suggest a possible benefit from estrogen therapy when combined with exercise.

However, the role of estrogen in muscle mass is not yet clear for postmenopausal women, the researchers said in the paper published in the journal “Menopause”.

For the  study, the team included 2,373 postmenopausal women (mean age 62.4 years).

Out of these 8.2 per cent met the criteria for developing
sarcopenia.

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