Some hormone replacement therapy (HRT) pills that contain both estrogen and progestin are associated with an increased risk of heart disease and rare but serious blood clots, known as venous thromboembolism (VTE), in women around the age of menopause, according to a study conducted in Sweden and published by ‘The BMJ‘.
The report also points to another medication, tibolonewhich was associated with an increased risk of heart disease, myocardial infarction, and stroke, but not blood clots.
The researchers note that these findings highlight the diverse effects of different hormonal combinations and delivery methods on the risk of cardiovascular disease.
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 trials have suggested a relationship between menopausal hormone therapy and increased risk of cardiovascular disease, but there is little information about the risks associated with different types of treatment during the menopausal transition.
To address this question, Swedish researchers set out to evaluate the effect of current menopausal hormone therapy on the risk of cardiovascular disease, depending on the route of administration and the combination of hormones.
eight groups
The findings are based on data from 138 emulated trials (observational studies that mimic clinical trials), involving 919,614 healthy Swedish women, aged 50 to 58, between 2007 and 2020, who had not used hormone therapy in the two years. previous.
Women with a history of heart disease, stroke, narrowed arteries or cancer were excluded, as were those who had undergone surgery to remove the ovaries, hysterectomy or sterilization.
Using monthly prescription records, women were assigned to one of eight menopause hormone treatment groups: oral continuous combination therapy, oral sequential combination therapy, non-combined oral estrogen, oral estrogen with local progestin, tibolone, combined transdermal therapy , oral non-combined transdermal estrogen or without hormonal therapy.
Hospital records were then used to track cardiovascular events over two years, taking into account influential factors such as age, educational level, region of residence, hypertension and diabetes.
During this follow-up period, 24,089 cardiovascular events were recorded among the 919,614 women in the study.
The results show that starting oral continuous combination hormone therapy or tibolone increases the risk of ischemic heart disease, with approximately 11 new cases per 1,000 women per year.
No risk with patches, gels, creams…
On the other hand, no increase in cardiovascular risk was found in transdermal treatments (patches, gels and creams). An increased risk of blood clots was also seen in several hormonal therapies, such as continuous oral combination and transdermal combination, with seven new cases of venous thromboembolism per 1,000 women.
These are observational findings, the authors caution. Therefore, no firm conclusions can be drawn about causality, and the authors highlight limitations such as the lack of data on menopausal status and the possibility that other unmeasured factors, such as smoking and body mass index, may have influenced the results. results.
However, by using an emulated trial design, they reduced the bias common in observational studies and the use of registry data allowed them to differentiate between different types of hormonal therapies, including delivery methods, regimens, and hormonal combinations.
The researchers suggest that future research should examine the possible effects of different progestogens used in menopausal hormone therapy on the risk of cardiovascular diseases.
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