A new research developed by scholars
ofUppsala University pointed out that i oral contraceptives and the hormone therapy in menopause increase the risk of stroke. The increased risk is greatest during the first year of treatment and then decreases. The study was based on data from over a quarter of a million women from the database UK Biobank.
The results of the Research have been published in the scientific journal Stroke.
Hormone therapy in menopause and stroke-related oral contraceptives: here’s why
“Women who started taking oral contraceptives had double the risk of having a stroke, but only during the first year of use. If they continued to take oral contraceptives, the risk decreased and after more than a year of use, we no longer saw any increased risk.“, he has declared Therese Johansson of the Department of Immunology, Genetics and Pathology of the University of Uppsala and one of the principal investigators of the study.
Worldwide, stroke is the second most common cause of disability and premature death, accounting for 11% of the total number of deaths each year. Stroke is caused by impaired blood flow to the brain, either due to a blockage caused by a blood clot, a brain infarction, or due to a brain hemorrhage.
So-called estrogen-containing exogenous hormones can be taken as oral contraceptives to protect against unwanted pregnancy or as hormone therapy during menopause to compensate for the loss of estrogen that occurs at that time. Hormone therapy helps reduce many symptoms of menopause, including hot flashes, vaginal dryness, and mood swings.
Estrogen has been shown to have a protective effect on vascular health, but are also associated with an increased risk of blood clots. In the current study, which was based on data from the UK Biobank biomedical database, the researchers compared the incidence of stroke, as well as the specific subtypes, cerebral infarction and cerebral haemorrhage, between women who took exogenous hormones and those who they didn’t.
“At the age when women usually start taking oral contraceptives, very few experience a stroke. The difference in lifelong risk between those who have taken oral contraceptives and those who have not is therefore small, even if there is an increased risk in the short term “Therese Johansson added.
Hormone therapy has previously been linked to an increased risk of stroke when taken several years after menopause. It has also been assessed that it can protect against stroke when taken before or shortly after menopause.
“We found an increased risk of both versions of stroke, cerebral infarction and cerebral hemorrhage, in the first year of hormone therapy, and the risk of cerebral infarction remained elevated after the first year. Unlike previous research, we have found an increased risk of stroke among women who started hormone therapy before menopause.“, he has declared Åsa Johansson, one of the authors of the study.
“But we also could see that women who had not had hormone therapy also had an increased risk of stroke at the onset of menopause, while those who had been treated did not have an increased risk of stroke when they began menopause.“Added Åsa Johansson.
“Importantly, most women tolerate exogenous hormones well and can benefit from their positive effects. Oral contraceptives allow women to prevent unplanned pregnancies and can also prevent many diseases that affect women, including ovarian cancer and endometrial cancer“, Therese Johansson intervened.
“Hormone therapy can significantly improve quality of life by relieving menopausal symptoms and can also prevent osteoporosis.However, some women have an increased risk of stroke with the use of exogenous hormones, and our results may allow women and doctors to make more informed decisions about which women should use hormonesJohansson concluded.
Special attention deserves early menopause, before the age of 40, which in this period of life can cause an increased risk of stroke due to blocked blood vessels. However, for every year of late menopause, the risk of stroke decreased by 2%.
Some research shows that women who enter menopause at an early age have a higher risk of heart disease in general. But research has produced conflicting results on the relationship between stroke and the age at which menopause began. The research carefully studied data from 16,244 postmenopausal women, aged 26 to 70, in the Netherlands.
After following women for about 15 years and adapting various factors, the researchers found that women whose menopause occurred before age 40 had a 1.5 times greater risk of ischemic stroke than women who did. experienced between 50 and 54 years. The researchers also found a 2% lower risk of stroke for each year that menopause was delayed.
The risk between early menopause and stroke is limited to ischemic stroke, which is caused by a blockage of blood vessels, and not hemorrhagic stroke, which occurs when a weakened vessel ruptures. The study also found that the link between age at menopause and stroke was stronger for women who experienced natural menopause than those who experienced menopause after surgery to remove the ovaries.
“It is of the utmost importance for all women to try to achieve optimal cardiovascular health before and after menopause, but it is even more important for women in early menopause.“, Said the Doctor Yvonne van der Schouwco-author of the study and Professor of Chronic Disease Epidemiology at theUtrecht University in the Netherlands.
“The results indicate the need for new research on the link between early menopause and stroke risk “van der Schouw said, adding that further studies “They could eventually lead to new as yet unknown paths and new clues for preventive measures ”.
The team of researchers has already studied how hormone replacement therapies in early menopause could improve cardiovascular health. According to a scientific statement from the AHA published last year in its journal Circulationsome hormone replacement therapies have cardiovascular benefits, reduce the risk of type 2 diabetes, and protect against bone loss.
A growing body of research is also looking at the impact of estrogen on a woman’s brain health. A 2019 study in the journal Menopause found that giving women estrogen early, within the first five years of menopause, could protect against cognitive decline. He also showed that women exposed longer to natural estrogen due to longer reproductive periods demonstrated better cognitive function later in life.
Doctor Samar El Khoudary, who was not involved in the new research, said the study was limited by using data that relied on participants’ questionnaires to report menopause details. However, he stated: “This study and other similar studies help us make ourselves more aware of the risks associated with menopause when it comes to cardiovascular health ”.
According to the scholar, more research is needed to study the impact of HRT on age in menopause and stroke. “It’s the big elephant in the room (since) middle-aged women use hormone therapy to treat symptoms related to menopause“Said El Khoudary, associate professor of epidemiology at the Clinical and Translational Science Institute ofUniversity of Pittsburgh.
Regardless of whether or not they use HRT, postmenopausal women need to learn about the risk of stroke and what they can do to prevent it, El Khoudary explained: “During middle age, as women go through menopause, they need to maintain physical activity, have a healthy diet and regular weight, quit smoking and get enough sleep. At this stage, risk reduction becomes very important“Concluded El Khoudary.
It can be concluded by observing that hormone therapy, depending on the period in which it is administered, has a higher or lower incidence of the risk of suffering a stroke. It is up to the general practitioner and trusted gynecologist to direct women to the therapy that is most suited to the circumstances. Of course, we must not neglect a healthy lifestyle, made up of a balanced diet and constant physical activity.
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