A recent study has warned that taking hormone replacement therapy in pill form may increase the risk of blood clots by 60%.
While the same risk does not appear to be associated with hormonal treatments administered transdermally, such as patches, gels, and sprays.
Hormone replacement therapy is widely used to relieve menopausal symptoms, such as hot flashes, and can also help prevent osteoporosis.
Researchers analyzed data from more than one million Danish women aged between 50 and 69, during the period between 2003 and 2021. During the study period, 9,807 women suffered serious blood clots, while 18,460 had strokes, and 11,974 had heart attacks.
The researchers found that oral hormone replacement therapy was associated with a 60% increased risk of blood clots, whether using estrogen alone or in combination with estrogen and progesterone.
High doses of the medication have also been linked to an increased risk of heart disease and stroke. Taking more than 1 mg daily for more than five years was associated with up to an 80% increased risk of heart attacks and strokes. Using high doses for more than a year was associated with a 40% increased risk of heart attacks and a 50% increased risk of stroke.
Researchers believe the reason lies in how the hormones reach the body. When estrogen is taken orally, it passes through the liver, which may stimulate the production of proteins that aid blood clotting. Treatments administered transdermally, however, enter the bloodstream directly, bypassing the liver.
The researchers said the findings confirm the importance of choosing the type of treatment, dosage, and duration of use according to each woman's health condition, especially for women who are more prone to strokes.
Dr. Robert Storey, a professor of cardiology at the University of Sheffield, who was not involved in the study, said the findings highlight the importance of controlling cardiovascular risk factors in users of oral hormone replacement therapy, noting the higher safety profile associated with patches compared to pills.
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