engleski

Hormone Therapy And The Risk Of Stroke

Hormone replacement therapy (HRT) has been well established as an effective treatment for controlling menopausal symptoms ; it has also been used for the prevention of cardiovascular disease, osteoporosis and dementia but evidence supporting its use for these indications is largely observational. Systematic review of randomized double blind trials of HRT versus placebo in relatively healthy women and combined continuous HRT have shown an significant increase of the risk of venous thromboembolism or coronary event (after 1 year of use), stroke (after 3 years), breast cancer (after 5 years) and gallbladder disease ; in women older than 65 years there was a significant increase in the incidence of dementia. The Women's Health Initiative (WHI) clinical trial of conjugated equine estrogens (CEE) was stopped early owing to lack of overall health benefit and even increased risk of stroke and dementia. The overall risk of taking HRT is still uncertain because of the complex actions of oestrogen at different doses, in combination with progesterone, the presence or absence of atherosclerotic risk factors and time for initiation of treatment may affect the risk of stroke. Recent clinical trials have found that lower doses of oestrogen and/or progestin maintain bone mineral density, however, the impact of lower doses of hormones on heart disease, venous thromboembolism and stroke remain to be determined in future studies. New trials will be needed to establish whether early intervention with oestrogen may prevent cerebrovascular disease or dementia.

Hormone therapy; stroke; risk factors

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