Vaginal Estrogen and Stroke Risk

We get a lot of questions from women who would benefit from vaginal/topical estrogen but are appropriately concerned about increased risk for heart attack and stroke with estrogen supplementation.

A new study in the journal Stroke suggests that even amongst women who would be high or above average risk for stroke, use of vaginal estradiol was not associated with excess risk for recurrent ischemic stroke in this population. And this was true at doses as high as > 50ug per week.

Interestingly, this study specifically sought out women who had already had a prior ischemic stroke before any hormonal therapy. So theoretically these women are already at increased stroke risk (or recurrent risk in this case) as compared to the general population.

While not directly studied here, presumably this could be extrapolated to include ischemic heart attack risk as well.

Haddadan KG et al. Recurrent ischemic stroke and vaginal estradiol in women with prior ischemic stroke: A nationwide nested case-control study. Stroke 2025 Oct; 56:3888