Little evidence has emerged that hormone replacement therapy could protect women against heart disease, experts say today.
Instead long-term treatment may increase the risk of stroke, according to an analysis by the Cochrane Library.
The findings confirm researchers’ conclusions earlier this century that claims that HRT could protect the heart were mostly false.
But they suggest women may gain some benefit immediately after the menopause.
Advocates had argued that women’s increased risk of heart disease after the menopause was caused by reduced levels of hormones.
The latest study analyses the findings of trials looking at the effects of taking the therapy for periods of at least six months, involving more than 40,000 women around the world. Some took the treatment for up to ten years.
The researchers said there was limited evidence that women starting treatment within the first ten years of the menopause might enjoy small protection against heart attacks – but they still faced an increased risk of deep vein thrombosis.
Researcher Dr Henry Boardman, a cardiologist at Oxford University, UK, said: “The evidence we have provides some support for the so-called ‘Timing Hypothesis’, but we should bear in mind the size of this effect.
"When we looked at the results according to the age of women, or by how long since their menopause that they started treatment, we found that if 1,000 women under 60 years old started hormone therapy we would expect six fewer deaths, eight fewer cases of heart disease and five extra blood clots over about seven years, compared to 1,000 similar women who did not start hormone therapy.
"The findings of this Cochrane review need to be carefully considered. This is a complicated health issue, where the same treatment offers benefits in some women, but harms in others.”
He added: "Hormone therapy remains a valid treatment option for women who are significantly troubled by menopausal symptoms, however the risks and benefits of such treatment vary according to age and medical history."
Maureen Talbot, of the British Heart Foundation, said: “This study supports what we already know and indicates a possible increased risk of stroke or formation of a blood clot in some women.
“It is important that women have a full understanding of the risks and benefits of HRT and should talk this through with their GP."
Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews 10 March 2015; doi: 10.1002/14651858.CD002229.pub4. [abstract]
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