Long term benefits and risks of HRT

Question 1

Venous Thromboembolism and manopause

Answer 1

• The risk of venous thromboembolism (VTE) is increased by oral HRT compared with baseline population risk
• The risk of VTE associated with HRT is greater for oral than transdermal preparations
• The risk associated with transdermal HRT given at standard therapeutic doses is no greater than baseline population risk.
• Consider transdermal rather than oral HRT for menopausal women who are at increased risk of VTE, including those with a BMI over 30 kg/m2
• Refer to hematologist if high risk VTE prior to start HRT

Question 2

Cardiovascular disease and menopause

Answer 2

• HRT does not increase cardiovascular disease risk when started in women aged under 60 years
• HRT does not affect the risk of dying from cardiovascular disease
• The presence of cardiovascular risk factors is not a contraindication to HRT as long as they are optimally managed.
  the baseline risk of coronary heart disease and stroke for women around menopausal age varies from one woman to another according to the presence of cardiovascular risk factors
• HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease
• HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease.
• Taking oral (but not transdermal) oestrogen is associated with a small increase in the risk of stroke. The baseline population risk of stroke in women aged under 60 years is very low.

Question 3

Absolute risk of cardiovasular disease in postmenopausal women in the UK and current users of HRT

Answer 3

26. 3/1000
    - Women on estrogen alone: 6 fewers
    - Women on estrogen and progesterone: 5 more

Question 4

Absolute risk of stroke in postmenopausal women in the UK and current users of HRT

Answer 4

11. 3/1000
    - Women on estrogen alone: 0
    - Women on estrogen and progesterone: 6 more

Question 5

Type 2 diabetes and HRT

Answer 5

No increased risk and no effect on blood glucose

Question 6

Breast Ca and HRT

Answer 6

• The baseline risk of breast cancer for women around menopausal age varies from one woman to another according to the presence of underlying risk factors
• HRT with oestrogen alone is associated with little or no change in the risk of breast cancer
• HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer
• Any increase in the risk of breast cancer is related to treatment duration and reduces after stopping HRT.

Question 7

Absolute risk of Breast Ca in menopausal women and adjusted risk with HRT

Answer 7

22. 48/1000
    - HRT with estrogen only: 4 fewer
    - HRT with estrogen and progesterone: 5 more

Question 8

Osteoporosis and HRT

Answer 8

• The risk of fragility fracture is decreased while taking HRT and this benefit:
  is maintained during treatment but decreases once treatment stops
  may continue for longer in women who take HRT for longer