The potential long-term risks associated with hormonal treatments for genitourinary syndrome of menopause (GSM), particularly vaginal estrogen and ospemifene, primarily revolve around the possibility of stimulating the growth of the uterine lining, which could increase the risk of uterine cancer. Although current studies have not shown a significant increase in uterine cancer risk with short-term use, the lack of long-term data raises concerns, especially for women who may require these treatments indefinitely. Additionally, there are uncertainties regarding the safety of these treatments in women with pre-existing conditions such as cardiovascular issues or a history of cancer, as these populations were often excluded from clinical trials.
To mitigate these risks, clinicians should adopt a cautious approach by closely monitoring women who are on long-term hormonal therapy for GSM. This includes regular gynecological evaluations and discussions about the benefits and risks of continued treatment. Furthermore, healthcare providers should consider individual patient risk factors, such as family history and personal medical history, when prescribing these treatments. Engaging in shared decision-making with patients can also empower them to make informed choices about their treatment options, balancing the relief of GSM symptoms with potential long-term risks.