Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.
Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.
In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).
The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:
- Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
- High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
- Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
- Findings remained even after adjustments were made for factors that might influence results, including age
What the findings mean
Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.
As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.
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As someone in the process of coming off oral HRT, I hear coming off the patch can be even more difficult. I’m having to work with my ob/gyn and an acupuncturist to ease off HRT and begin a more natural method of treating my symptoms.
What sort of difficulties arise in coming off the patch Susan?
The only real difficulties is the weaning off process only because knowing how much your body is absorbing isn’t as defined as with pills. I certainly don’t want to sound completely discouraging, it is doable by reducing the size of the patch.
I am only speaking from internet research I’ve done in my quest to come off oral HRT.
Thanks Susan. I’ll look into this – perhaps another blog post!
Overall great posts this week…already forwarded to several friends contemplating the hormone patch.
thanks again for your great work!
I’ve been using HRT (oestrogen only) for the past 17 years .. firstly pills and in the last 3 years a gel. In both cases trying to wean off HRT is a nightmare and there really is no other course of action other than to either stay with it and the risks involved or come off and put up with the side effects. I’m 68 now, in good health and look and feel at least 10 years younger than most people of my age, and to be honest I’ve got to the point where I’m just keeping on HRT until my GP refuses to prescrib it any longer. I KNOW the risks involved and at the moment am prepared to take those risk rather than go through all those awful night sweats for weeks and months. If there was a standard one could say was the optimum time you’d have to put up with symptoms it would be a whole lot easier, but each woman is different… some get symptoms for a relatively shortly time, others like one of my friends is still having flushes and sweats after 3 years! It may relate of course to the length of time you take HRT.. the problem is we just don’t know. Long term research hasn’t been carried out yet. The only advice I can give is to come off it gradually .. ie. use alternate days, then every 3 days, the 4 days etc. That can ease things rather than the big withdrawal thing.
I wish everyone luck. It’s the devil and the deep blue sea I’m afraid!
What a thoughtful and informative comment Fran. I truly appreciate you sharing your experience and your concerns. It’s true that coming off of HRT can be as awful and not being on it for some women, but there are ways to wean off the hormones and incorporate herbs. I’d recommend you speak to a licensed practitioner who is versed in herbal strategies to see if there is possibly a safe and effective solution that might work for you. Thanks again!
I had a hysterectomy 20 years ago and have been on HRT since then…first Premarin and Climara 0.05 the last 8 or 9 years. Changing doctors prompted the changed in treatment and I was pleased to have the patch and did not experienced any difficulties with the switch from pills to patch. I had slowly gained 20 pounds after my surgery and being on HRT…which my doctor said had nothing do with the surgery or HRT. She said “if you don’t put it in your mouth you won’t gain more weight.” Not exactly the help I was looking for and I eventually found another doctor. At the time of surgery I weighed 120 lbs and am 5′ 6″…. when I changed to Climara I weighed 140lb. To further complicate things I was later diagnosed with depression and have been taking Lexapro, 10 mg for 7 years. I’ve unsuccessfully attempted 3 times to wean off Lexapro and each time the mood swings, crying and general feeling of hopelessness were so bad that my husband convinced me that it’s wasn’t worth giving it up to feel that badly. I’m now resigned to staying on the Lexapro but want to wean off the patch. Have done some research and found that I can cut the Climara patch. I plan on cutting a third off and see how I do and on my next doctor’s visit ask her to give me script for the 3.75. I believe Climara coupled with Lexapro has added to the weight gain which now has me topping the scales at 169. I’m afraid if I don’t discontinue one of these the weight gain will continue to climb, my cholesterol will worsen along with my general health. As you might have guessed….I’m not too active and I know that’s a start, at least to walk but in all honesty other than my gardening and housekeeping I’m probably not going to until fall. Mall walking isn’t my thing, when it’s not 100 degrees I love walking the neighborhood.Oh, I’m 65.
Would love to see posts from anyone who has successfully discontinued the patch and experienced any weight loss and hear how they have dealt with the hot flashes etc. I plan to begin my journey next week and will update as it progresses. Fingers crossed.
@sjones169 I am sorry for this journey you’ve been on. There are excellent alternatives to HRT, many of which are detailed in this blog. However, transitioning can be tough. I highly recommend that you seek the advice of a practitioner who is well versed in chinese medicine and even acupuncture who can assist with the change.