“Although the risks of blood clots and stroke increase with either type of hormone therapy, the risk is rare in women ages 50-59”.1

Umbrella
What may the Hormone Therapy and Stroke Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Cardiovascular Disease
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)
  • Stroke

Stroke

What is a stroke?

DotS the definition of a stroke may vary. The American Stroke Association’s definition is:

“A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die”.2

Revised Global Consensus Statement

Is there an association between menopausal hormone therapy (MHT) and the risk of stroke?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

Hormone Therapy and Stroke

  • “The risk of venous thromboembolism (VTE) and ischemic stroke increases with oral MHT, although the absolute risk of stroke with initiation of MHT before age 60 years is rare. Observational studies and a meta-analysis point to a probable lower risk of VTE and possibly stroke with transdermal therapy (0.05 mg twice weekly or lower) compared to oral therapy”.3

What is VTE?

VTE can be an abbreviation for Venous Thromboembolism.

NICE Guidelines

What do the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about HT and the risk of stroke?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT the NICE note about Heart Disease and Stroke (Cardiovascular Disease):

“Studies show that:

  • If you start HRT before you’re 60 it does not increase your risk of cardiovascular disease
  • HRT does not affect your risk of dying from cardiovascular disease
  • HRT tablets (but not patches or gels) slightly raise the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.
If you’re already at higher risk of cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your GP can give you more information”.4

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Risk

What else is known about HT and the risk of stroke?

One of the major points of agreement in the joint statement 15 Top Medical Organizations Agree on Hormone Therapy: 10 Years Have Passed Since Women’s Health Initiative Raised Questions dated 09 July 2012, is:

  • “Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and stroke increase with either type of hormone therapy, the risk is rare in women ages 50-59”.5

Health Care Provider

If I choose to use HT what is my risk of stroke?

Different women who choose to use HT can have different risks of stroke. It may therefore be in your best interest to also choose to talk to your health care provider about this.

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.6

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. 15 Top Medical Organizations Agree on Hormone Therapy Use: 10 Years Have Passed Since Women’s Health Initiative Raised Questions. 09 July 2012:3. North American Menopause Society, the American Society for Reproductive Medicine and the Endocrine Society https://www.menopause.org/docs/default-document-library/pr12solidarity.pdf?sfvrsn=2 Accessed: 04 June 2020
  2. About Stroke. American Stroke Association https://www.stroke.org/en/about-stroke Accessed: 04 June 2020
  3. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 04 June 2020
  4. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT – Heart Disease and Stroke (Cardiovascular Disease). National Institute for Health and Care Excellence. Published Date: 12 November 2015. Last Updated: 05 December 2019.  https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 04 June 2020
  5. 15 Top Medical Organizations Agree on Hormone Therapy Use: 10 Years Have Passed Since Women’s Health Initiative Raised Questions. 09 July 2012:3. North American Menopause Society, the American Society for Reproductive Medicine and the Endocrine Society https://www.menopause.org/docs/default-document-library/pr12solidarity.pdf?sfvrsn=2 Accessed: 04 June 2020
  6. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 04 June 2020
Topic Last Updated: 04 June 2020 – Topic Last Reviewed: 04 June 2020
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