Oral Hormone Therapy Linked to Higher Cardiovascular Risks Than Transdermal Alternatives, Study Finds
A groundbreaking Swedish study published in BMJ Medicine has revealed that oral hormone therapy poses a significantly higher risk of cardiovascular disease compared to cutaneous hormone supplementation administered through plasters. The research, conducted by a team from Uppsala University, analyzed data from over 900,000 Swedish women aged 50 to 58 between 2007 and 2020. using an innovative approach to emulate a hypothetical randomized controlled trial, the study aimed to establish causal relationships with greater reliability.
The findings were stark: women undergoing oral estrogen-progestin therapy faced elevated risks of heart disease and venous thromboembolism (VTE). Specifically, oral supplementation of Tibolon, a combined estrogen-progesterone preparation, was associated with increased risks of heart disease, cerebral infarction, and myocardial infarction. In contrast, cutaneous hormone supplementation involving only estrogen was deemed safe, while combined transdermal governance of estrogen and progestagens showed a slightly increased risk of VTE.
The Role of Progestagens
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The study’s conclusions sparked a response from two French gynecologists specializing in menopause,who argued that the
Oral vs. Transdermal Hormone Therapy: A Deep Dive into Cardiovascular Risks and safety
A recent BMJ Medicine study conducted by researchers at Uppsala University has shed new light on the risks associated with hormone replacement therapy (HRT).The study,which analyzed data from over 900,000 Swedish women aged 50 to 58,found that oral hormone therapy significantly increases the risk of cardiovascular diseases,including heart disease,cerebral infarction,and myocardial infarction,compared to transdermal (cutaneous) hormone supplementation. To better understand these findings, we sat down with Dr. Marie Dubois, a renowned gynecologist and menopause specialist, to discuss the implications of this groundbreaking research.
The Study’s Key Findings: Oral vs. Transdermal Therapy
Senior Editor: Dr. dubois, the study highlights that oral estrogen-progestin therapy carries a higher risk of cardiovascular disease compared to transdermal hormone therapy. Can you explain why this might be the case?
Dr.Marie Dubois: Certainly. The difference lies in how the body processes these two forms of therapy. Oral hormone therapy passes through the liver first, where it undergoes a metabolic process known as the ”first-pass effect.” This process can increase the production of clotting factors and inflammatory markers, which elevate the risk of conditions like venous thromboembolism (VTE) and heart disease. In contrast, transdermal hormone therapy is absorbed directly into the bloodstream through the skin, bypassing the liver. This method is less likely to trigger these adverse metabolic changes, making it a safer option for manny women.
Understanding the Role of Progestagens
Senior Editor: The study also mentions that progestagens play a significant role in these risks. Could you elaborate on how they contribute to cardiovascular complications?
Dr. Marie Dubois: Absolutely. Progestagens, which are often combined with estrogen in hormone therapy, can have varying effects on the cardiovascular system. Some progestagens, like those found in Tibolon, may promote blood clotting and increase the risk of cerebral infarction and myocardial infarction. the study found that transdermal therapy with only estrogen was deemed safe, but the addition of progestagens slightly increased the risk of VTE. This suggests that the type and route of administration of progestagens are crucial factors to consider when prescribing HRT.
Implications for Menopause Management
Senior Editor: What are the key takeaways for healthcare providers and women considering hormone therapy for menopause management?
Dr. Marie Dubois: The primary takeaway is that not all hormone therapies are equal in terms of safety. For women with a history of cardiovascular disease or those at high risk for VTE, transdermal estrogen therapy is likely the safer option.However, if progestagens are required, careful consideration should be given to the type and delivery method. It’s also important to individualize treatment based on a patient’s medical history and risk factors. Regular monitoring and open communication between patients and healthcare providers are essential to minimize risks and maximize benefits.
Addressing Criticisms and Future Research
Senior Editor: The study has sparked some debate among experts. What are yoru thoughts on the criticisms, and where do you see future research heading in this field?
dr. Marie Dubois: It’s not uncommon for groundbreaking studies to generate discussion, especially in a field as nuanced as menopause therapy. Some experts argue that the study’s emulation of a randomized controlled trial, while innovative, may not fully account for all confounding variables. However, the sheer scale of the study—over 900,000 participants—adds significant weight to its findings.Moving forward, I’d like to see more research on the specific effects of different progestagens, as well as long-term studies comparing the safety and efficacy of oral versus transdermal therapies. This will help us refine our guidelines and provide even safer options for women.
Concluding Thoughts
Senior Editor: Thank you, Dr. Dubois, for your insightful analysis. To summarize, the study highlights the importance of choosing the right type and method of hormone therapy to minimize cardiovascular risks. For many women, transdermal estrogen therapy appears to be the safer choice, especially when progestagens are not required. However, individualized treatment plans and ongoing research remain essential to ensure the best outcomes for women managing menopause symptoms.
