Research reveals different risks of hormone therapy for menopausal symptoms

Researchers at Uppsala University analyzed the effects of seven different hormone treatments for menopausal symptoms on the risk of blood clots, stroke and heart attack. The study, which included nearly 1 million women aged 50 to 58, showed that risks vary depending on the active ingredient and how the drug is taken. The study, published in the scientific journal BMJ, is the world's largest and most comprehensive study of currently prescribed hormonal substances.

There is concern among women that hormone therapy during menopause may increase the risk of cardiovascular disease. This concern is based on older studies conducted more than 20 years ago that looked at only one type of treatment. Although many new formulations have been introduced since then, our study shows that previous conclusions do not apply to all types of therapy. ”

Therese Johansson, Postdoctoral Researcher at Uppsala University and lead author of the study

Most women reach menopause between the ages of 50 and 60. Levels of the hormone estrogen drop rapidly, increasing the risk of osteoporosis. Low levels can also cause health problems such as hot flashes, mood swings, and sleep problems. To combat these health effects, women may be prescribed hormone replacement therapy, which uses drugs that contain hormones or hormone-like substances.

In Sweden alone, hundreds of thousands of women are currently using hormone replacement therapy, and this type of treatment has been available since the 1970s. At the time, there was only one type of hormone replacement therapy, and its use declined rapidly after large studies in the 1990s showed an increased risk of cardiovascular disease. Since then, new preparations have been introduced to the market, and with this, the use of hormone replacement therapy in connection with menopause has increased significantly in recent years.

In the new study, researchers looked at seven types of hormone replacement therapy currently in use, administered via tablets, hormone patches, or hormone-releasing IUDs. The study was based on all prescriptions for hormone replacement therapy in Sweden from 2007 to 2020, and included approximately 1 million women aged 50 to 58. The women were monitored for two years after starting hormone replacement therapy. The risk of blood clots and cardiovascular disease was compared between women who received prescription drugs for hormone replacement therapy and those who did not.

These results clearly demonstrate that the risks of hormone replacement therapy vary depending on the type of treatment.

For example, tibolone, a synthetic hormone that mimics the effects of the body's natural hormones, was associated with an increased risk of both heart attack and stroke, but not with an increased risk of blood clots. The risk of heart attack or stroke from tibolone is estimated to be 1 in 1,000 women.

Mixed preparations containing both estrogen and progesterone Instead, it increases your risk of blood clots, including: deep vein thrombosis. A blood clot can form in a vein, break off and travel to the lungs in the circulation, causing a pulmonary embolism. Researchers estimate that the risk of deep vein thrombosis with this combination product is approximately 7 per 1,000 women per year.

“It is important that both doctors and women are aware of the risks of menopausal hormone therapy, and in particular that existing drugs carry different risks of blood clots and cardiovascular disease. Tibolone in particular Tibolone is used in Europe but is not approved in countries such as the United States. We hope that our study will lead to the discontinuation of this drug,” says research group leader Åsa Johansson from Uppsala. University and SciLifeLab researcher and lead author of this study.

Although an approximately 50 percent increase in hormone patch use was observed during the study period from 2007 to 2020, these preparations were not associated with a similarly high risk. Increased use of safer alternatives, such as patches, is an important step forward in reducing the risk of cardiovascular disease in menopausal women.

“The next step in our research is to develop strategies to identify women who are at increased risk for certain diseases related to the use of hormone medications. This will allow us to guide patients to the best medication for each individual. “There are many side effects,'' says Åsa Johansson.