Hormone Replacement Therapy: Pill or Patch?

Hormone replacement therapy (HRT) is regularly prescribed to women for the relief of hot flushes, night sweats and other symptoms of menopause. Currently, about 1 million women taking Hormone replacement therapy, with an estimated three out of four using the pill. Previous studies have shown HRT to be associated with an increased risk of coronary heart disease, breast cancer and venous thromboembolism (VTE), a potentially fatal blood clot in the veins. Although these studies has prompted millions of women to abandon HRT drugs, they did not access the benefit / risk to women or if the risk varies depending on the type of treatment.

However, French researchers recently completed an investigation into the risk of blood clots from two different forms of HRT, the pill and patch. Dr. Pierre-Yves Scarabin, research director at the National Institute of Health and Medical Research and his colleagues examined data from eight studies observation and nine randomized controlled trials on HRT and VDTs and found that Women taking oral HRT had double the risk of blood clots compared to women who use skin patches, and 2.5 times the risk for women not taking estrogen. They also found the risk to be significantly higher during the first year of treatment and women who were overweight or prone to develop blood clots. The increased risk translates into another group of 11 cases per 10000 women each year based on a combination HRT, in both cases by 10000 for estrogen only HRT, according to the study authors. Women who stopped taking HRT risks have seen their return to normalcy.

The researchers said that the reason for this difference in risk between oral, and the patch may be due to how estrogen is absorbed into the bloodstream. When taken orally, estrogen entering the digestive system and is processed by the liver. This process could undermine the balance between clotting and the fight against clotting factors in the blood. The authors added that, like most data came from observing trials, the results should be interpreted with caution.

Other experts, like Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York, agrees. "It is observation and very interesting, but it is clear that more studies should be made. Perhaps this opens the door to a way of giving hormones to more safely to those in need, "she said.

Dr. John Stevenson, president of Women's Health Concern, which provides advice to women in menopause, said that the increased risk of VTE for HRT users is well recognized. "It is linked to estrogen and is dose-dependent, so that the risk can be reduced by using lower doses or non-oral such as patches."

Still others see the study as flawed. The International Menopause Society (IMS) issued a statement just days before the French study was published in the online edition of the British Medical Journal indicating that for women in their 50, HRT was safe and effective and not not increase the risk of heart disease. The group also concluded that HRT had a "minimal" impact on the risk of breast cancer. "The SSI Group of Experts concluded that the only residual risk of HRT in the age group 50-59 years was that of an event thromboembolic a blood clot," said Dr. David Sturdee, British gynaecologist and President of IMS. "This very slight increased risk of a blood clot should not discourage healthy women using HRT if it is needed."

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