Estrogen Therapy and Stroke Risk in Menopausal Women
In life, there are often times when answers seem elusive, and assessing the overall risks between estrogen therapy and stroke tends to fall into that category. There have been many studies performed over the years on how women respond to hormone replacement therapy, including the WHI (the Women’s Health Initiative), the HERS (Heart Estrogen-Progestin Replacement Study), the Nurses’ Health Study, and others. Some of these focused their findings on strokes while others had alternate primary goals and included stroke research as an auxiliary outcome.
In general, the overall estrogen therapy stroke risk was not found significant. The HERS study did focus its research on women with previous qualifying ischemic stroke or transient ischemic attack. The women who were chosen to participate met all related criteria and were placed in one of two groups – those receiving estradiol (estrogen) alone, or those receiving a placebo. The women did not know which group they had been assigned.
By the end of the follow-up period, there was a slightly higher incidence of stroke in the group who received estradiol. Although not a significant increase, it was enough to negate the possibility of using estrogen to prevent further strokes in menopausal or postmenopausal women.
Assessing the Benefits vs. Stroke Risks of Estrogen Therapy
Although the rates have declined in the past few decades, stroke is still the third leading cause of death in women. The risk of impaired mental and physical functions following a stroke is another issue that leads to finding a way to prevent this condition in the first place. Doctors have wondered if using estrogen therapy and stroke prevention could be conjoined. Unfortunately, 29 studies reviewed over the past 25 years have not produced any conclusive evidence that benefits exist.
What we do know is that there appears to be a level of protection for women from stroke and heart disease before menopause. This may be due to the protective nature of ovarian hormones, such as estrogen, testosterone, and progesterone. Estrogen’s positive effects on the body include improved vascular reactivity, vasodilatation, enhanced neurogenesis, angiogenic effects, positive impact on lipids, and antithrombotic effects.
Although these benefits were thought to bring a reason for the use of estrogen replacement therapy and stroke risk prevention, the general study findings did not support a reason for doctors to prescribe estrogen replacement as a way to avoid strokes.
How to Minimize the Risk of Stroke from Estrogen Therapy
Under no circumstances should estrogen replacement be prescribed for the sole purpose of preventing a stroke, whether initially or subsequently. There is a possibility that transdermal estrogen would not have the same estrogen therapy stroke risk as oral estrogen. Further studies need to be completed in this area.
The symptoms associated with menopause can have serious health consequences in addition to severely affecting a woman’s quality of life. The need is great for the use of proper hormone replacement therapy to prevent the above from occurring or to restore positive mood and functions. However, this must be done the safest way possible with a goal of preventing adverse reactions.
When considering estrogen replacement therapy, stroke avoidance is going to be a factor. First of all, the increased risk of stroke is very small. While ERT cannot and should not be used as a preventative treatment, it can still have positive benefits. Alternately, there are other forms of hormone therapy including bioidentical progesterone and testosterone that can provide health benefits while reducing the symptoms of menopause. These treatments do not carry the same adverse risk factors as estrogen and progestin therapies and are viable alternatives for many women.
It is essential to point out that no form of hormone therapy should ever be used without first undergoing blood analysis to detect which levels are low enough to warrant replacement treatment. The doctors here at Kingsberg Medical can arrange for these tests at local labs throughout the US to diagnose and treat hormone decline and menopause in the safest and most affordable way possible. Please contact us for a no-cost, no obligation consultation.