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January 07, 2005
In the past, HRT was believed
to protect against heart disease and stroke, but with more
trials the balance of evidence has
shifted. Most experts do not recommend the use of HRT except
for brief periods, and the new analysis, which pools the results
of 28 trials involving nearly 40,000 women, is likely to discourage
many more.
The results, published on the online version of
the British Medical Journal, show that strokes are increased
by 29 per cent in women on HRT. The effect is seen in ischaemic
strokes, caused by blockages of blood flow to the brain, not
in the less common form of haemorrhagic stroke, caused by bleeding
within the brain.
Fatal or disabling strokes are increased
by 56 per cent in women on HRT, while minor and transient stokes
that do less long-term damage are not affected. The team, from
the University of Nottingham, said that patients with a high
risk of stroke should stop taking HRT unless there is a strong
medical reason not to.
The trials reviewed included a US study
from the Women’s Health Initiative that in 2002 linked HRT
with higher risks of breast cancer, heart attack and stroke.
Last year the study, which involved almost 17,000 women over
50, said that those taking HRT for five years doubled the risk
of life-threatening blood clots.
The Royal College of Obstetricians
and Gynaecologists has advised that HRT should be used only
in the short term to relieve menopausal symptoms.
The team,
led by Professor Philip Bath, said: “A poor outcome after stroke,
judged as combined death and dependency, was increased by half
with hormone replacement therapy. We also found a significant
increase in non-fatal stroke.”
They said it was not clear why
HRT should increase the risk of stroke and its severity.
The
review will raise further concerns among women seeking treatment
for symptoms of the menopause, which include debilitating hot
flushes, insomnia, headaches and irritability.
The number of
prescriptions for HRT has fallen as more trials have emerged
highlighting dangers. But experts say that in the short term
the benefits can outweigh the risks because of improvements
to quality of life with the relief of severe menopausal symptoms.
The researchers said: “We found that the use of hormone replacement
therapy is associated with an increased risk of stroke, typically
ischaemic in type and severe in nature.
"HRT cannot be recommended
for the primary or secondary prevention of stroke."
"Extrapolation
of the data suggests that patients at high risk of stroke — such
as those with previous stroke, coronary heart disease or multiple
vascular risk factors — should stop taking it unless there
is a strong contrary medical reason.”
© 2005 Times
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Menopause