Stories this week in the media focused on the fact that HRT may be safer when given as low-dose patches than as pills. Two things to say on that – firstly ‘may’ isn’t that positive and secondly if you read the study carefully your risk of stroke is at its lowest if you don’t take HRT at all.
A Canadian and German study of the records of 75,000 patients between 1987 and 2006 found patches containing low doses of oestrogen carried a lower risk of stroke than oral HRT and the risk rose with high-dose patches.
I would say the risk rose with ‘high-dose’ synthetic hormones themselves rather than patches, and certainly if you are taking HRT the best medical advice is to take the lowest effective dose for the shortest time necessary. Or indeed, not at all and take natural progesterone and oestrogen instead to manage menopause symptoms.
Certainly all the recent research has raised concerns about an increased risk of breast cancer, heart attacks and strokes associated with use of HRT. Women on the high-dose patches had an increased stroke risk of up to 88% and those on oral HRT had a 25-30% increased risk of stroke compared with those who used none, regardless of what dose of oestrogen they took or whether or not it was combined with progesterone.
This indicates yet again that women need to be very cautious about oestrogen intake in menopause and should certainly look seriously at balancing it with natural progesterone, or using a form of natural oestrogen – not synthetic.
Over 2.5 million women in the UK take HRT and Dr John Stephenson, Reader in Metabolic Medicine at Imperial College and Chairman of the Women’s Health Concern (shame they don’t have an actually women heading that concern) says that the vast majority of women are on low doses of HRT and this is a relative increase of 35% in the risk of a stroke which he says comes down to 0.7% which is negligible.
It depends on whether you are one of the unfortunate ones who has had a stroke as to whether you consider it negligible I would have thought. He goes on to say that women can be completely reassured and there is no need for them to come off HRT as when it’s given appropriately the benefits far outweigh the risks.
I seem to have heard this before, and I guess my definition of when it’s appropriate and his would probably diverge. It seems to me that even a small risk will impact on a substantial number of women. Interestingly one UK national newspaper when reporting this also claimed that HRT has been shown to maintain bone strength in older women and cut the risk of bowel cancer.
They must be reading different reports from those I have seen. In the photograph they chose to illustrate their article they show a woman with what is clearly a hormone patch on her right shoulder at the back about on a level with the heart – something that I believe is not recommended by anyone, even doctors who approve of it.
I would also like to know who has funded the research as that can often have a bearing on the outcome – what do you think?