Researchers from Uppsala University analysed seven hormone treatment options for menopausal symptomatology and the effect on blood clots. strokes, or heart attacks. This study involved approximately one million women between the ages of 50-58. It showed that risks vary depending on how and what active substance is used.
This is the most extensive and largest study ever conducted on the hormonal drugs currently prescribed in the world. It was published in BMJ. Therese Johannsson is the lead researcher of this study and postdoctoral research at Uppsala University. Menopause is most common between 50-60 years of age. The levels of the hormone, oestrogen, drop sharply and increase the risk of developing osteoporosis. Low levels of oestrogen can cause health issues such as mood swings, hot flashes, and sleep problems. Women may receive hormone replacement therapy, which involves medicines that contain hormones or substances similar to hormones.
The Swedish government reports that hundreds of thousands women use the hormone replacement therapy. This type of treatment is available in Sweden since 1970. In the 1970s, the only type of hormonal replacement therapy was available. When a large study showed in the 1990s that the treatment increased cardiovascular risk, the use of the hormone replacement therapy rapidly decreased. In the last few years, hormone replacement therapy has become more popular in menopause. This is due to the introduction of new products on the market.
Researchers examined seven types of hormone replacement therapies, including tablets, patches, and hormone-releasing IUDs. This study covers almost one million Swedish women between the ages of 50 and 58. It is based upon all hormone replacement therapy prescriptions in Sweden, from 2007 until 2020. Women were followed for two years following the start of hormone replacement therapy. Women who collected prescription medicines for hormone therapy and those women who did not were compared in terms of their risk of cardiovascular disease and blood clots. Results show that hormone replacement therapy risks vary according to the treatment type.
The synthetic hormone, tibolone (which mimics body natural hormones), was associated with an increased heart attack risk and stroke risk, but not an increase in blood clot risk. One in 1,000 women is at risk for a heart attack or stroke caused by tibolone. Combination preparations that contain both progesterone and oestrogen increase blood clots including deep veins thrombosis.
The blood clots can form in veins, and then break free and move with circulation into the lungs. This leads to pulmonary embolism. Researchers estimate the risk of deep venous thrombosis from this combination preparation to be around seven women per 1,000 per year. Asa Johansson is the senior author of this study and leader of the research group at Uppsala University.
Over the course of the study period, from 2007 to 2020, a 50 percent increase was seen in the usage of hormonal patches. These preparations, however, were not associated with the higher risks. Patches are a safer alternative that can reduce the cardiovascular risk in women who have reached menopause.
“The next step in our research will be to develop strategies to identify which women are at increased risk of certain diseases in connection with using hormonal drugs. In this way, we can guide patients to the most appropriate medicine for each individual and drastically reduce the number of side effects,” Asa Johansson says.
