Hormonal health
Different menopausal hormone treatments pose different risks

The largest and most comprehensive study of currently prescribed hormone treatments has found that the risk of blood clots, stroke and heart attack differ depending on the active substance and how the medicine is taken.
Researchers analysed the effects of seven different hormone treatments for menopausal symptoms on the risk of blood clots, stroke and heart attack. The study involved around one million women aged between 50 and 58.
“There is concern among women that menopausal hormone therapy increases the risk of cardiovascular disease,” said lead author Therese Johansson of Uppsala University.
“This concern is based on older studies conducted more than 20 years ago that only looked at one type of treatment. Since then, many new preparations have been introduced and our study shows that the previous conclusions do not apply to all types of treatments.”
Most women go through menopause between the ages of 50 and 60. Levels of the hormone oestrogen fall sharply, increasing the risk of osteoporosis. The low levels can also contribute to health problems such as hot flushes, mood swings and difficulty sleeping.
To counteract these health effects, women may be prescribed hormone replacement therapy involving medicines containing hormones or hormone-like substances.
In Sweden alone, hundreds of thousands of women currently use hormone replacement therapy and this type of treatment has been available since the 1970s. At that time, there was only one type of hormone replacement therapy and when a major study in the 1990s showed that it increased the risk of cardiovascular disease, its use rapidly declined.
Since then, new preparations have entered the market, and following this, the use of hormone replacement therapy in connection with menopause has increased significantly in recent years.
In the new study, the researchers looked at seven different types of currently used hormone replacement treatments, administered via tablets, hormone patches or hormone-releasing IUDs. The study is based on all prescriptions for hormone replacement therapy in Sweden from 2007 to 2020 and covers nearly one million women aged 50 to 58.
The women were monitored for two years after starting hormone replacement therapy. The risk of blood clots and cardiovascular disease was compared between women who had and had not collected a prescription medicine for hormone replacement therapy.
The results show clearly that the risks of hormone replacement therapy vary depending on the type of treatment.
For example, the synthetic hormone tibolone, which mimics the effects of the body’s natural hormones, was linked to an increased risk of both heart attack and stroke, but not to an increased risk of blood clots. The risk of heart attack or stroke due to tibolone is estimated at one in a thousand women.
Combined preparations containing both oestrogen and progesterone instead increase the risk of blood clots, including deep vein thrombosis. Blood clots form in the veins and can break loose and travel with the circulation to the lungs, leading to pulmonary embolism. The researchers estimate that the risk of deep vein thrombosis resulting from this combined preparation is about seven per thousand women per year.
“It is important that both doctors and women are aware of the risks of menopausal hormone therapy and, in particular, that the existing drugs carry different risks of blood clots and cardiovascular disease,” said senior author Åsa Johansson.
Tibolone in particular was associated with an increased risk of stroke and heart attack. Tibolone is used in Europe but is not approved in countries such as the United States. We hope that our study will lead to the drug being withdrawn from use here as well.”
During the period of the study, 2007 to 2020, an increase in the use of hormone patches of about 50 per cent was observed, and these preparations were not linked to the same higher risk. The increased use of safer alternatives, such as patches, is an important step forward in reducing the risk of cardiovascular disease among menopausal women.
“The next step in our research will be to develop strategies to identify which women are at increased risk of certain diseases in connection with using hormonal drugs. In this way, we can guide patients to the most appropriate medicine for each individual and drastically reduce the number of side effects,” Johansson said.
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Non-hormonal menopause pill approved for NHS use

A new daily menopause pill approved for NHS use could bring relief to women with debilitating hot flushes and night sweats.
Around 500,000 women are expected to be eligible for the treatment, which experts say could help those unable to take hormone replacement therapy, or HRT.
The drug, fezolinetant, also known as Veoza, is a daily non-hormonal tablet designed to target the brain signals that trigger some of the most disruptive menopause symptoms.
In final draft guidance published today, the National Institute for Health and Care Excellence recommended the 45mg tablet for women experiencing moderate to severe hot flushes and night sweats.
More than two million women in the UK are thought to suffer these symptoms during menopause, often beginning during the earlier stage known as perimenopause.
For many, the effects are severe, disrupting sleep, affecting concentration and straining relationships. In some cases women are even forced to cut back on work.
An estimated 60,000 women in the UK are currently out of work or on long-term sick leave due to severe menopause symptoms, costing the economy roughly £1.5bn a year.
Research also suggests one in 10 women has left the workforce entirely because of a lack of support.
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