HRT – It’s Not What You Take, but How You Take It

There have been conflicting reports about whether taking hormone replacement therapy (HRT) to relieve the symptoms of menopause is linked to an increased likelihood of having a heart attack (a myocardial infarction, or MI). Danish researchers, reporting in the European Heart Journal, followed all the healthy Danish women between 50 and 65 – almost 700,000 of them – over 5 years. Data on their HRT use were obtained from the national prescription registry; other national registers identified the 5,000 odd heart attacks among these women. The researchers analyzed the relationship between the risk of heart attack and the influence of age, duration of HRT, the treatment regimen and route used, the type of progestagen, and the dose of estrogen.

Overall, there was no increased risk of heart attack in women taking HRT compared with women who never used this form of therapy. There was a 19% reduction in risk in women who were former users of HRT. In the younger age group (50 to 55) there was a 24% increase in risk with longer use of HRT, but no significant increases in the other age groups.

The highest risk of heart attack – a 35% increase – was found with continuous combined HRT, compared with never-users. Dermal use (i.e. the patch) and vaginal administration of estrogen only both carried significantly reduced risks of heart attack: -38% and -44%, respectively.

Based on these results, it would seem obvious that women with menopausal symptoms should try to confine their HRT to a dermal patch or oral administration of estrogen, and limit the duration of treatments. There are, of course, reports of other risk increases with HRT , so the limitation to short treatment periods is sensible for all women, even if they are taking oral combination meds.