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| Courtesy: menopausemoxie.com |
Route of
menopausal hormone therapy plays a very important role in increasing or
decreasing the risk of stroke in postmenopausal women reports the results of
large Danish national historical study. The study was originally published in June 2017 in Journal Stroke.
Randomized
trials have shown an increased risk of stroke and the study was not completed
because of higher risk faced by study participants.
This large
epidemiological study included nearly all women aged 51 to 70 years living in
Denmark and the cohort was recruited by linking 5 Danish registries, that
provided data about hormone therapy exposure and stroke diagnoses
(ischemic/hemorrhagic/subarachnoid hemorrhage).
Of, nearly a
million women included in the study, 36% used hormone therapy. 2% women (20 199)
suffered a stroke.
Current
users of hormones were 16 % at increased risk of stroke as compared to never
users (RR) 1.16 (95% CI 1.12–1.22), but the risk of hemorrhagic stroke
decreased RR: 0.80 (95% CI, 0.70–0.91).
Users of oral
continuous, cyclic combined estrogen/progestin, and estrogen only were at 29%,
11% and 18% more at risk respectively for all strokes as compared to never
users. The increased risk was because of ischemic stroke, but not hemorrhagic
stroke.
Transdermal
HT is safer and does not lead to increased risk of stroke. Unopposed
transdermal estrogen therapy had a protective effect, it decreases the risk by
18% (RR 0.82; 95% CI 0.69-0.98).
Vaginal HT
was also protective and decreased the risk of stroke by 35% (RR 0.65; 95% CI
0.59-0.70).
Tibolone use
increased the stroke risk by nearly 30%, including haemorrhagic.
The authors
concluded that, “we found an increased risk of stroke, based on ischemic
stroke, with oral hormone therapies that was comparable to findings from
randomized studies. We found no risk of stroke with transdermal application and
a reduced risk with vaginal estrogen.”
