Hrt: risk higher before menopause

Physicians who freely prescribe hormone replacement therapy (HRT) to women who are approaching, but have not yet reached, menopause may be increasing the woman's risk of developing venous thromboembolism (VTE).

Several studies originally published in the Lancet appeared at first to throw up a contradiction namely, the higher risk of VTE in women who'd used HRT for short periods of time (Lancet, 1996; 348: 977-80; also 348: 981-3; 348: 983-7; 348: 1027).

While this may at first seem illogical, further analysis of the data shows that the group most likely to use HRT over the short term are perimenopausal women. Because these women are still ovulating, and thus still producing estrogen, the addition of HRT produces a massive overdose of estrogen which can lead to VTE (Lancet, 1996; 348: 1668).

For more information on HRT see the special reports in WDDTY vol 4, nos 9 & 10. For alternatives to HRT see Q&A WDDTY vol 4 no 11.