Blood Clots Linked to Oral Hormone Replacement for Menopause Symptoms Interview with:

Yana Vinogradova, PhD Research Fellow Department of Primary Care School of Medicine University of Nottingham University Park, Nottingham

Dr. Vinogradova

Yana Vinogradova, PhD
Research Fellow
Department of Primary Care
School of Medicine
University of Nottingham
University Park, Nottingham What is the background for this study?  

Response: The study targeted middle age women going through menopause.  This is the stage of life when women naturally reach the end of their reproductive life and their hormones gradually decrease.  Some women experience unpleasant effects such as hot flushes, night sweats, mood swings, memory and concentration loss, headaches.  Quality of life may be severely affected.  Hormone replacement therapy uses a class of drugs, which, like all drugs, have side effects.   VTE is a serious side effect which can have a lethal outcome.

There are different preparations of hormones available for such women.  Some of them were extensively studied in a large American Trial Women’s Health Initiative and showed the risk of VTE to be twice as high for women who took them.  However, these well-studied drugs are mostly prescribed in America.  The more popular drugs in Europe and the UK have been much less studied, so it was unclear how they compared. What are the main findings?

Response: Compared with women who have not been prescribed HRT, the study found that, while women on hormone replacement therapy tablets had significantly increased risk of venous thromboembolism, women using HRT patches or gels had almost no change in risk.  In comparisons between HRT tablets, it also found that the more studied drugs, based on conjugated equine estrogen, were associated with higher risk than those based on synthetic estradiol. What should readers take away from your report?

Response: Although hormone replacement therapy medications are generally relatively safe, the background risk of venous thromboembolism increases with age and with presence of other risk factors.   Patches and gels should perhaps be considered as a first choice because of no evidence of increased risk from using them.  If for some reason this treatment route is not acceptable then there is a wide choice of tablets – and preference should be given to those based on synthetic estradiol rather than conjugated equine estrogen. What recommendations do you have for future research as a result of this work?

Response: Venous thromboembolism is a relatively uncommon event so choices regarding HRT drugs does depend on a patient’s characteristics and choice.  A randomised control trial is unlikely to deliver more useful information.  A comparable study which had available more details about actual use (rather than just prescription information), women’s choices, and other VTE risk factors could improve the accuracy and reliability of the study findings.

The study was not funded and the authors have nothing to disclose.


Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases

BMJ 2019; 364 doi: (Published 09 January 2019)Cite this as: BMJ 2019;364:k4810 


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