Risk of cardiovascular outcomes in users of estradiol/dydrogesterone or other HRT preparations

  title={Risk of cardiovascular outcomes in users of estradiol/dydrogesterone or other HRT preparations},
  author={Cornelia Schneider and Susan S. Jick and Christoph R. Meier},
  pages={445 - 453}
Background Use of postmenopausal hormone replacement therapy (HRT) used to be promoted to reduce the risk of ischemic cardiovascular diseases, a concept which has been challenged by results of the large Women's Health Initiative trial in users of estrogen and progestin. It is postulated that the type of progestin used in HRT affects the cardiovascular risk. Methods We used the UK-based General Practice Research Database to conduct a follow-up study with a nested case–control analysis. We… 

The use of menopausal hormone therapy in women at high cardiovascular risk

The adoption of clinical decisions on the use of MHT in conditions of high CVR and the presence of individual clinically significant risk factors should be carried out by a multidisciplinary team, which will exclude both unmotivated prohibitions and appointments in the absence of contraindications.

Pulmonary embolism in menopausal hormone therapy: a population-based register study

The risk of PE was significantly increased in users of oral but not transdermal MHT, with the highest risk in first ever users of Oral estrogen combined with medroxyprogesterone acetate, probably because of the healthy user effect.

Cardiac Death Risk in Relation to the Age at Initiation or the Progestin Component of Hormone Therapies.

In all hormone users, the CHD death risk was smaller the earlier the use of ET or EPT had started (P < .05); this phenomenon was unrelated to the progestin component of EPT.

Menopausal hormone therapy and heart disease prevention: desired or valid?

The concept of “window of opportunities” is described, in accordance with which an improvement in cardiovascular prognosis can be expected only at the onset of MHT in women under the age of 60 years in early postmenopause ( menopause duration <10 years).

Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women

Transdermal estrogens may improve substantially the benefit/risk ratio of postmenopausal hormone therapy and should be considered as a safer option, especially for women at high risk for VTE.

MAS position statement: Managing menopausal women with a personal or amily history of VTE

Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk, and strongly suggest that both the route of estrogen administration and the type of progestin may be important determinants of the overall benefit-risk profile of HT.

Hormone therapy and risk of venous thromboembolism among postmenopausal women

Individual assessment of the benefit–risk ratio is needed before initiating treatment and oral estrogens should be avoided among women at high risk for venous thromboembolism, but norpregnane derivatives might be thrombogenic.



Hormone Therapy and Venous Thromboembolism Among Postmenopausal Women: Impact of the Route of Estrogen Administration and Progestogens: The ESTHER Study

Oral but not transdermal estrogen is associated with an increased VTE risk, and data suggest that norpregnane derivatives may be thrombogenic, whereas micronized progesterone and pregnane derivatives appear safe with respect toThrombotic risk.

Postmenopausal hormone replacement therapy: scientific review.

Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain, according to a meta-analysis of 22 estrogen trials, cohort studies, results of the WHI, and trials with bone density outcomes.

Estrogen plus progestin and risk of venous thrombosis

Estrogen plus progestin therapy was associated with doubling the risk of venous thrombosis and the risks associated with age, overweight or obesity, and factor V Leiden were increased.

Association between hormone replacement therapy and subsequent arterial and venous vascular events: a meta-analysis

HRT is associated with an increased risk of stroke, stroke severity, and VTE, but not of CHD events, and combined HRT increases the risk of VTE compared with oestrogen monotherapy.

Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy.

Hormone therapy is associated with an increased risk of stroke, and this increased risk does not appear to be related to the timing of the initiation of HT, in younger women, with lower stroke risk.

Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis.

The finding that conjugated equine estrogen but not esterified estrogen was associated with venous thrombotic risk needs to be replicated and may have implications for the choice of hormones in perimenopausal and postmenopausal women.

Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women : systematic review and meta-analysis

Oestrogen but not transdermal oestrogen increased the risk of venous thromboembolism, especially during the first year of treatment, and the combination of oestrogens and thrombogenicmutations or obesity further enhanced the risk.