MENOPAUSE: Each HRT has its risks and effects

Most women go through menopause between the ages of 50 and 60, and this transition is accompanied by a drop in estrogen levels, which increases the risk of osteoporosis. These low levels can also contribute to the well-known symptoms of hot flashes, mood swings and trouble sleeping. To counter these health effects, women may be prescribed hormone replacement therapy involving medications containing hormones or related substances.

Around the world, hundreds of thousands of women use hormone replacement therapy. When the first HRT were put on the market in the 1970s, several studies highlighted the risk of cardiovascular diseases, which mechanically reduced their prescription and use. Since then, new preparations have arrived on the market and the use of HRT has expanded considerably.

The studythe largest and most comprehensive study in the world ever conducted on currently prescribed hormonal substances, analyzes the effects of 7 hormonal treatments, administered in the form of tablets, patches or hormonal IUDs, aimed at managing the symptoms of menopause on the risk of blood clots, stroke and heart attack. The study included around 1 million women aged 50 to 58 taking this type of treatment. The analysis reveals that:

• the risks differ depending on the active substance and how the medicine is taken;

• the synthetic hormone tibolone, which mimics the effects of the body’s natural hormones, remains associated with an increased risk of heart attack and stroke, but not an increased risk of blood clots;
• the risk of heart attack or stroke linked to tibolone is estimated at 1/1,000;
• combined preparations containing both estrogen and progesterone, on the contrary, increase the risk of blood clots, including deep vein thrombosis; these blood clots form in the veins and can break off and travel with the circulation to the lungs, which can lead to a pulmonary embolism;
• the risk of deep vein thrombosis associated with these combined preparations is approximately 7/1,000;
• administration via hormonal patches does not appear linked to the same higher risk:

• increased use of safer alternatives, such as patches,

therefore constitutes an important advance in reducing the risk of cardiovascular disease in postmenopausal women.

The lead author, Therese Johansson, researcher in immunology, genetics and pathology at the University notes that “Women fear that hormonal treatment for menopause increases the risk of cardiovascular disease. This fear is based on older research, conducted more than 20 years ago, which only looked at one type of treatment. Since then, many new preparations have been introduced and this new study shows that these previous findings do not apply to all types of treatment.”

However, it is essential that doctors and women are aware of the risks of menopausal hormone therapy and different levels of risk of blood clots and cardiovascular disease.