From the Guidelines
Vaginal estrogen therapy can be safe for an 85-year-old woman when used appropriately and under medical supervision. For elderly women experiencing vaginal dryness, atrophy, or recurrent urinary tract infections, low-dose vaginal estrogen preparations are generally considered safe and effective, as supported by the most recent guidelines from the National Comprehensive Cancer Network 1. Common options include estradiol vaginal cream, estradiol vaginal tablets, or an estradiol vaginal ring, which result in minimal systemic absorption, making them safer than oral estrogen therapy.
Key Considerations
- Before starting treatment, a healthcare provider should evaluate the patient's medical history, particularly regarding breast cancer, unexplained vaginal bleeding, history of blood clots, or stroke.
- The lowest effective dose should be used for the shortest duration needed to relieve symptoms.
- Regular follow-up appointments are important to monitor for any adverse effects.
Safety and Efficacy
Unlike systemic hormone therapy, low-dose vaginal estrogen has not been associated with significant increased risks of cardiovascular disease, stroke, or breast cancer, making it appropriate for many elderly women when clinically indicated, as noted in a large cohort study of almost 50,000 patients with breast cancer followed for up to 20 years 1. However, it's crucial to consider the individual patient's risk factors and medical history before initiating treatment.
Alternatives and Additional Options
Other treatments like vaginal androgens (e.g., DHEA) and selective estrogen receptor modulators (e.g., ospemifene) may also be considered for vaginal dryness or pain with sexual activity, but their safety and efficacy in elderly women, especially those with a history of hormonally mediated cancers, are less well-established compared to vaginal estrogen therapy 1.
From the Research
Vaginal Estrogen Therapy Safety for 85-Year-Old Women
- The safety of vaginal estrogen therapy for an 85-year-old woman can be considered based on several studies that have evaluated the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause (GSM) 2.
- A systematic review of 53 studies found that vaginal estrogen products were effective and safe for the treatment of GSM, with few adverse effects reported 2.
- Another systematic review of 75 clinical trials found that vaginal estrogen preparations were safe, with few head-to-head comparisons and limited data on long-term use 3.
- The studies suggest that vaginal estrogen therapy can be safe for older women, but long-term trials are needed to fully assess the safety of vaginal estrogen use 3.
- A study on menopausal symptoms in older women found that hormone therapy, including vaginal estrogen, can reduce hot flashes, trouble sleeping, and vaginal dryness, but may be associated with vaginal discharge, genital irritation, uterine bleeding, and breast symptoms 4.
- The use of low-dose vaginal estrogen products, such as inserts or rings, may be associated with fewer increases in serum hormones and potentially greater safety 3.
- It is essential to note that while these studies provide evidence on the safety of vaginal estrogen therapy, individual results may vary, and the decision to use vaginal estrogen therapy should be made in consultation with a healthcare provider.