Menopause news

Heart and stroke risk after stopping HRT

19 February 2016

The debate around HRT and effect on heart disease and stroke risk continues. While concern has been expressed that HRT can increase risk, this risk appears only to apply when HRT is started in older women, eg after the age of 60. Evidence continues to emerge suggesting that use of HRT under the age of 60 or within 10 years of the menopause, can reduce risk; the so-called “window of opportunity”. Little information has been available to understand what happens to the cardiovascular system after HRT is stopped.

A recent report from Finland from a large observational study of 332,202 women who stopped HRT and were studied over 15 years has added to this debate. It has shown that compared to background population, the mortality rate for heart and stroke was higher in women who stopped HRT in the first year after stopping and thereafter. Further, the mortality rate comparison was highest in women who stopped HRT compared to those who continued taking HRT. When analysed by age, the increased mortality rate was higher in women who stopped HRT under the age of 60, but there was no increase in women who stopped HRT over the age of 60.

These new findings add support to the “window of opportunity” theory in which HRT is thought to provide benefit to the cardiovascular system when started early and while it is taken. The greatest harm after stopping appeared to be in women who stopped HRT under the age of 60, whether HRT was used for less than or more than 5 years.

Many women choose to stop HRT after a short time, or may be advised to do so. While this may be entirely appropriate, it may be necessary to consider cardiovascular risk, and of course give full consideration to other factors such as diet and lifestyle which may help to reduce risk.

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