Vaginal Estradiol Shows No Added Risk of Repeat Stroke in Women: Daily Dose

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On August 21, 2025, we reported on a study published in Stroke that was designed to examine the association between the use of vaginal estradiol tablet and the rate of recurrent ischemic stroke in women with a history of ischemic stroke.

The study

Researchers conducted a nationwide nested case-control study of 34 274 women aged 45 years and older who experienced a first ischemic stroke in Denmark between 2008 and 2017. Among these, 3353 cases of recurrent stroke were identified and matched by birth year to 3353 controls. The median age was 75 years.

The findings

When adjusted for comorbidities, medications, income, and education, vaginal estradiol exposure was not associated with an increased rate of recurrent ischemic stroke. The adjusted hazard ratio (aHR) for current use (within 0–3 months before the index date) was 0.79 (95% CI, 0.52–1.20; P = .27). For recent use (3–24 months before the index date), the aHR was 1.09 (95% CI, 0.73–1.63; P = .67), and for past use (>24 months before the index date), the aHR was 1.48 (95% CI, 0.95–2.30; P = .08). Results did not differ by dose or cumulative exposure.

Authors' comments

"In this nested case-control study, use of vaginal estradiol tablets was not associated with an increased rate of recurrent ischemic stroke in women with a history of ischemic stroke. Based on our findings, vaginal estradiol tablets are not likely to increase the risk of recurrent ischemic stroke in women with prior stroke."

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