Hormone replacement therapy

Hormone replacement therapy (HRT), often used to control symptoms of menopause, was previously thought to protect against cardiovascular disease. However, a meta-analysis found no protective effect of HRT and an overall increase in stroke risk by about 25%, driven mainly by primary prevention trials (there was no increase in risk for secondary prevention trials, which mainly included patients with heart disease).

The effect of HRT on stroke and TIA risk is present in younger women and increases with age. HRT significantly increases the risk of venous thromboembolism and pulmonary embolism.

Some women may still wish to continue with HRT for control of menopausal symptoms and an enhanced quality of life. In these situations, the decision whether to continue HRT should be discussed with the patient and based on an overall assessment of risk and benefit.

For current research and evidence-based recommendations see our Clinical Guidelines.