Related Topics: HRT, Opinion

HRT Patches and Health Risks

HRT may be safer when given as low-dose patches than as pills, but does that mean it’s safe?

AnnA Rushton

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?

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AnnA Rushton | 2:54 pm, June 14th, 2010

Claudia -Natural progesterone cream has been in use for many years for menopausal symptoms and altough oestrogen levels naturally fall at menopause, so too does progesterone.

There are other sources of oestrogen available to women at this time as it continues to be made in the fat cells, and there are many sources of xeno oestrogens women are exposed to from the environment.

There is no doubt some women need additional oestrogen at menopause and there are bio-identical oestrogens available for women who prefer to have an all-natural version of HRT. There has been some research and much anecdotal evidence available on natural progesterone and other bio-identical hormones for their effectiveness for menopause symptoms, particularly osteoporosis.

However, as natural progesterone cannot be patented, there is little advantage to funding research in this area for the major pharmaceutical companies, who are the chief sponsors of such trials.

You mention Serenity progesterone cream and that is one of those recommended by Dr John Lee, the pioneer in natural progesterone usage, as it contains the amount of progesterone stated by him to be optimal for helping reduce symptoms of hormone imbalance and does contain bio-identical pharmaceutical grade USP natural progesterone as stated in their literature.

AnnA Rushton | 3:41 pm, June 7th, 2010

Hear, hear Glenda – and to my mind the greatest health supplement ever is boundless amounts of joy – zips up the immune system faster than anything in my experience!

Glenda de Vries | 3:35 pm, June 7th, 2010

Thank your for this information.

I just wish menopausal sites would discuss the benefits of lifestyle changes when it comes to menopausal symptoms.

Diet, exercise, relaxation and joy are several changes we all should be making in our lives.

jonathanr | 2:37 pm, June 7th, 2010

I agree with the estrogen dominance point. I think that premise begins with the simple fact that dysregulated high levels of estrogen in an unhealthy pregnancy (which has nutritional factors such as vitamin deficiencies and inadequate progesterone) can put a woman’s life and future health at risk. Therefore, giving an older woman this very same hormone, especially in “youthful” quantities, is going to be problematic.

All in all, for me, this really calls into question the necessity of “replacement” estrogen for any reason other than premature menopause and high risk for osteoporosis. Granted, I think progesterone (by itself and not in artifical form as progestin) is deserving of more study as it is often dinged as unnecessary or the “bad guy” in HRT’s side effects. But I believe in waiting for such studies’ results before jumping on any bandwagon.

AnnA Rushton | 8:50 am, June 7th, 2010

Indeed Jonathan – it is certainly my view that HRT carries risks, and as you will from other posts the risks of oestrogen dominance and the links between oestrogen and cancer are well known and reported.

However, I have always believed in letting people know about all the information there is out there so they can make an informed choice.

For some women HRT is a choice they want to make, and if they do with all the information to hand – knowing the risks – then that is their right.

jonathanr | 5:11 am, June 7th, 2010

“synthetic” patches? most patches in europe and this country use bioidentical estradiol. so this not so subtle implication that bioidentical estradiol is safe and beneficial for women is not grounded in hard science.

women with high estradiol later in life are at greater risk for a number of health problems, including certain cancers, stroke, and dementia. and estradiol has already failed miserably in the few small clinical trials that have been done, which howed higher risks of recurrent stroke and heart attack in women with established disease. you can also look at this new study in a different way – regular strength or high dose estradiol patches pose equal or greater risk than synthetic estrogens in pill form.

doctors have known for a long time that a woman’s own estrogen can pose risks. and the only true “bioidentical” hormone source is a woman’s own body. so all in all, HRT – regardless of the source/dose/method of delivery – is not going to be risk free.

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