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Current use of oral menopausal hormone therapy (commonly known as hormone replacement therapy or HRT) is associated with an increased risk of blood clots in the legs or lungs regardless of dose or treatment duration, finds a large Danish study published by The BMJ.

Conversely, stroke and heart attack risks were limited to prolonged use of high-dose oral hormone therapy, while transdermal hormone therapy (delivered via the skin as patches, gels or sprays) showed no general increased blood clot risk.

Hormone therapy relieves menopausal symptoms such as hot flashes and night sweats. Some studies have linked oral hormone therapy to rare but serious blood clots known as venous thromboembolism and stroke, but evidence for heart attack remains inconsistent.

To explore this further, researchers searched Danish health registry data for women ages 50–69 living in Denmark between 2003 and 2021 who were diagnosed with a first venous thromboembolism, ischemic stroke or heart attack (myocardial infarction).

They identified 9,807 women with venous thromboembolism, 18,460 women with ischemic stroke and 11,974 women with heart attack. These women were matched by birth year to a total of 49,035, 92,300 and 59,870 women without thrombotic disease, respectively.

Prescription records were then used to assess links between hormone therapy use and thrombotic disease according to several variables, including route of administration, dose, duration of use and age at treatment initiation.

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