Key result
Current menopausal hormone therapy linked to ~3-fold higher ischemic stroke risk vs never-users.
Why the study?
Does menopausal hormone therapy increase the risk of ischemic stroke in women aged 45-60 years without underlying cardiovascular disease?
Cohort (n=19,055)
Does menopausal hormone therapy increase the risk of ischemic stroke in women aged 45-60 years without underlying cardiovascular disease?
Hazard Ratio: 2.98 (95% CI 1.95–4.57)
p-value: p=<0.001
Current use of menopausal hormone therapy, particularly estrogen-only or tibolone, is associated with a significantly increased risk of ischemic stroke in women aged 45-60 years, though this risk returns to baseline upon discontinuation.
Purpose: Most studies have reported that the risk of coronary heart disease decreases when menopausal hormone therapy (MHT) is initiated before the age of 60 years or within 10 years of menopause.However, the findings regarding stroke risk remain conflicting.This study investigated the association between the risk of ischemic stroke and MHT, categorized by the type of MHT. Materials and Methods: This population-based, retrospective cohort study was based on the Korean National Health Insurance Service-National Sample Cohort (2004-2015).Participants were aged 45-60 years with no cardiovascular disease or preexisting stroke, classified as never, past, and current users of MHT.Results: Among the study participants, 16915 (88.77%) women had never undergone MHT, 1437 (7.54%) had previously undergone MHT, and 703 (3.69%) were currently using MHT.During the study period, with a mean follow-up of 11.232.13years, the risk of ischemic events was significantly higher among current users [hazard ratio (HR): 2.98, 95% confidence interval (CI): 1.95-4.57,p<0.001], particularly in those using estrogen-only MHT (HR: 3.49, 95% CI: 1.12-10.90,p=0.032) and tibolone (HR: 3.52, 95% CI: 2.05-6.03,p<0.001), compared to never users.Meanwhile, no significant difference in the risk of ischemic events was observed between past users and never users, even after analyses accounting for estrogen type and progestin co-administration.Conclusion: Women currently receiving MHT without underlying cardiovascular disease exhibited an increased risk of ischemic stroke, particularly those treated with E-only MHT or tibolone.However, this increased risk returned to baseline after discontinuing MHT, indicating that past use of MHT was not associated with an increased risk of ischemic stroke.
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Choo et al. (2025) conducted a cohort in Menopause (n=19,055). Menopausal hormone therapy vs. Never users was evaluated on Ischemic stroke (HR 2.98, 95% CI 1.95-4.57, p=<0.001). Current use of menopausal hormone therapy increased the risk of ischemic stroke compared to never users (HR 2.98; 95% CI 1.95-4.57; p<0.001), particularly with estrogen-only therapy or tibolone.
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