What is HRT?

HRT typically stands for Hormone Replacement Therapy. Hormone Replacement Therapy relieves menopause symptoms in women by replenishing estrogen and progesterone hormones that the body no longer produces. Additionally, it addresses other hormonal imbalances or deficiencies, such as those in transgender hormone therapy or certain medical conditions.

What type of HRT has the lowest risk of Venous Thromboembolism (VTE) or Deep Vein Thrombosis (DVT)?

A large UK case-control study by Vinogradova, et al published in BMJ used 2 large UK databases to identify 80,396 women aged 40-79 who were diagnosed with VTE. These cases were then matched to a control group of 391,494 women.

  • 5,795 (7.2%) of women with VTE and 21,670 (5.5%) of women in the control group had exposure to HRT.
  • Of these women, 4,915 (85%) of the VTE group used an oral Hormone Replacement Therapy preparation while 880 (14%) used transdermal-only preparation (including mostly patches, but also gels, and subcutaneous versions).
  • In the control group, 16,938 (78%) used oral preparations while 4,731 (19%) used transdermal preparations.

All types of oral estrogen use demonstrated an increased risk of VTE with an OR of 1.58 compared to controls. When further breaking down the type of estrogen used, Conjugated Equine Estrogen (CEE, brand name Premarin) had a higher risk with OR 1.49 than estradiol (E2, brand name Estrace) with an OR of 1.27. Whereas, NONE of the transdermal routes of HRT increased risk of VTE (OR 0.93). They also found no increased risk of VTE with any type vaginal estrogen use.

Prior observational studies have been consistent with these results. And now with this large case control study, the data is clear that transdermal HRT should be the preferred route with no increased risk of VTE. However, if a patient greatly prefers oral estrogen, estradiol may be less risky in terms of VTE than conjugated equine estrogen. Conclusion: A TRANSDERMAL estrogen patch (along with progesterone if indicated) should be first line in Hormone Replacement Therapy.

What are the benefits of HRT?

Hormone Replacement Therapy (HRT) offers several benefits, particularly for women in menopause. Here are some advantages:

  1. Relief from Menopausal Symptoms: HRT can help with hot flashes, night sweats, mood swings, and vaginal dryness.
  2. Bone Health: It helps in maintaining bone density. This can reduce your risk of osteoporosis and fractures. Lower estrogen levels make this more common.
  3. Heart Health: May reduce the risk of heart disease.
  4. Improved Quality of Life
  5. Potential Cognitive Benefits: There is some evidence to suggest that HRT may help in maintaining cognitive function and reducing the risk of dementia, although more research is needed in this area.

HRT may not be suitable for everyone and can have risks. Discuss with your doctor.

What are the risks?

Hormone Replacement Therapy (HRT) can be beneficial, but it also comes with certain risks. Risks associated with HRT are as follows:

  1. Increased Risk of Certain Cancers: Long-term use, especially combined estrogen-progestin therapy, increases risk of breast cancer. Estrogen-only HRT may increase the risk of endometrial cancer if the uterus is intact.
  2. Blood Clots: The risk for these might increase.
  3. Stroke: Might slightly increase the risk of stroke, especially in older women or those who begin HRT later in life.
  4. Heart Disease: While HRT may have heart benefits if started around the time of menopause, starting HRT later may increase the risk of heart disease.
  5. Gallbladder Disease: Might increase the risk of gallbladder disease, including gallstones.
  6. Other Side Effects: Some women may experience side effects such as bloating, breast tenderness, headaches, and mood changes.

References: Vinogradova Yana, Coupland Carol, Hippisley-CoxJulia. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases BMJ 2019; 364 :k4810


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