Stroke

Is vaginal estradiol safe for women with a history of ischemic stroke?

August 25, 2025

Study details: This nationwide nested case-control study included 56,642 Danish women aged ≥45 years who experienced a first ischemic stroke between 2008 and 2017. Researchers identified 3,353 women with recurrent stroke and matched them 1:1 by birth year to controls without recurrence. Vaginal estradiol tablet use was categorized as current (0–3 months), recent (3–24 months), or past (>24 months before stroke recurrence).

Results: After adjusting for comorbidities, medications, income, and education, vaginal estradiol use wasn't associated with increased risk of recurrent ischemic stroke. The adjusted hazard ratios were 0.79 for current use (95% confidence interval [CI], 0.52-1.20; P=.27), 1.09 for recent use (95% CI, 0.73-1.63; P=0.67), and 1.48 for past use (95% CI, 0.95-2.30; P=.08), indicating no statistically significant associations.

Clinical impact: These findings provide reassurance that vaginal estradiol tablets, commonly used to treat genitourinary symptoms of menopause, may be safe for women with a history of ischemic stroke.

Source:

Haddadan KG, et al. (2025, August 21). Stroke. Recurrent Ischemic Stroke and Vaginal Estradiol in Women With Prior Ischemic Stroke: A Nationwide Nested Case-Control Study. https://pubmed.ncbi.nlm.nih.gov/40836911/