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Evidence summaries

Local Oestrogen and the Endometrium

Local oestrogen in postmenopausal women does not increase the risk of endometrial proliferation or hyperplasia. Level of evidence: "A"

For urogenital symptoms only, local oestrogen is recommended over systemic treatment in menopausal women. Local oestrogen is safe.

The recommendation is strong because local treatment has low costs, rarely has any harms, and may also be beneficial for sexual function.

A systematic review 1 included 20 randomized controlled studies, 8 interventional studies, and 10 observational studies. Collectively, there was no increased risk of endometrial hyperplasia or cancer with low-dose vaginal estrogens. Rates of endometrial cancer and hyperplasia were 0.03% and 0.4%, respectively (20 RCT, n=2983). Overall, reports of endometrial hyperplasia were observed with various doses and durations and appeared sporadic, consistent with endometrial hyperplasia rates in the general population. The Women's Health Initiative Observational Study showed no association (1.3 cases/1000 women-years with vaginal estrogens versus 1.0/1000 women-years for nonuse).

    References

    • Constantine GD, Graham S, Lapane K et al. Endometrial safety of low-dose vaginal estrogens in menopausal women: a systematic evidence review. Menopause 2019;26(7):800-807. [PubMed]

Primary/Secondary Keywords