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Question answered:03/04/08
It would appear that there is not enough evidence to answer this question.
A consensus statement published by the American National Institutes of Health in 2005 states [1]:
“Vaginal estrogen preparations to treat vaginal dryness and pain with intercourse may also be an attractive option for these women. Such topical therapies are known to increase circulating estrogen levels, but by much smaller amounts than oral estrogen therapy. Because these topical therapies have not been studied in large numbers of women for long periods of time, actual levels of risk for long-term complications, such as breast cancer occurrence or recurrence, while probably much lower than those of oral therapy, are not fully known.”
The CKS guideline on menopause [2] reports:
“Vaginal oestrogens:
Low-dose oestrogen therapy is preferred because it incurs no adverse endometrial effects and a progestogen is not required for endometrial protection [Rees and Purdie, 2006a]. Vaginal oestrogen therapy may be required long-term, as symptoms recur when treatment is stopped. However the endometrial safety of long term or repeated use of topical vaginal oestrogens is uncertain [CSM, 2003b].”
The CSM advice mentioned above, although focussed on endometrial cancer, suggests [3] using the lowest effective amount (to avoid systemic absorption) and to interrupt treatment at least annually to re-assess the need for treatment.
References
1) http://consensus.nih.gov/2005/2005MenopausalSymptomsSOS025PDF.pdf
2) http://cks.library.nhs.uk/menopause/view_whole_topic_review
3) http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON007450&RevisionSelectionMethod=LatestReleased
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