Some types of hormone therapy during menopause are associated with an increased risk of heart disease and blood clots

The report also points to another drug, tibolonewhich was associated with an increased risk of cardiovascular disease, heart attack and stroke, but not blood clots.

The researchers note that these results highlight the varied effects of different hormonal combinations and delivery methods on cardiovascular disease risk.

HRT is used to relieve menopausal symptoms such as hot flashes and night sweats, and there are different treatments depending on each woman’s symptoms.

Some previous studies have suggested a link between menopausal hormone therapy and an increased risk of cardiovascular disease, but there is little information about the risks associated with different treatments during the menopausal transition.

To answer this question, Swedish researchers decided to evaluate the effect of modern menopausal hormone therapy on the risk of cardiovascular disease depending on the route of administration and combination of hormones.

eight groups

The results are based on data from 138 emulated studies (observational studies that mimic clinical trials) involving 919,614 healthy Swedish women aged 50 to 58 years between 2007 and 2020 who had not used hormone therapy in the previous two years .

Women with heart disease, stroke, narrowed arteries or cancer, and those who had had spay surgery, hysterectomy or sterilization were excluded from the study.

Using monthly prescription records, women were assigned to one of eight menopausal hormone treatment groups: oral continuous combination therapy, oral sequential combination therapy, oral estrogen alone, oral estrogen with topical progestin, tibolone, combination transdermal therapy, or oral noncombination transdermal. estrogen or without hormone therapy.

Hospital records were then used to track cardiovascular events over two years, taking into account influential factors such as age, education level, region of residence, hypertension and diabetes.

During this observation period, 24,089 cardiovascular events were recorded among the 919,614 women participating in the study.

The results show that starting continuous oral combination hormone therapy or tibolone increases the risk of coronary heart disease: approximately 11 new cases per 1000 women per year.

No risk when using patches, gels, creams…

On the other hand, no increase in cardiovascular risk was found with transdermal treatment (patches, gels and creams). An increased risk of blood clots was also observed with certain hormonal therapies, such as continuous oral combination therapy and transdermal combination therapy, with seven new cases of venous thromboembolism per 1,000 women.

These are the results of observations, the authors warn. Thus, no firm conclusions about causality can be drawn, and the authors highlight limitations such as the lack of data on menopausal status and the possibility that the results may have been influenced by other unmeasured factors such as smoking and body mass index.

However, by using a simulated study design, they reduced the bias common in observational studies, and the use of registry data allowed them to differentiate between different types of hormone therapy, including delivery methods, regimens, and hormonal combinations.

Researchers suggest that future research The possible impact of different progestogens used in menopausal hormone therapy on the risk of cardiovascular disease should be studied.