- Each year about 25 million women around the world experience menopause.
- Hormone replacement therapy (HRT) is a treatment sometimes prescribed to people going through menopause, which has some potential complications, including blood clots and stroke.
- New research says that women with type 2 diabetes using HRT skin patches are not at a higher risk for blood clots or stroke.
- However, the study did find that women with type 2 diabetes taking oral HRT may increase their risk for pulmonary embolism and heart disease overall.
HRT is available in a variety of forms, including tablets, gels, rings, injections, and skin patches.
However, the study did find that women with type 2 diabetes taking oral HRT may increase their risk for pulmonary embolism — when a blood clot forms in a lung artery — and heart disease overall.
This research is yet to appear in a peer-reviewed journal.
For this study, researchers analyzed medical data from the TriNetX global database of more than 36,000 women with an average age of 59 from across the United States and Europe.
Participants were selected if they had started an HRT and statin — a medication used to help lower cholesterol levels — or just a statin prescription.
At the study’s conclusion, researchers found that study participants with type 2 diabetes taking transdermal HRT via skin patches had a 25% lower risk of developing heart disease, and no difference in risk for pulmonary embolism, DVT, stroke, or cancer, when compared to females with type 2 diabetes not taking HRT.
However, when looking at participants with type 2 diabetes taking oral HRT, they had double the risk of developing a pulmonary embolism, and a 21% higher chance for heart disease, when compared to participants taking transdermal HRT.
“Our study suggests that up to 5 years of regulator-approved doses of transdermal HRT appears safe in a large cohort of women in midlife with type 2 diabetes, and that the use of HRT skin patches is not associated with an excess increased risk of cardiovascular complications or estrogen-sensitive cancers when compared to women with type 2 diabetes who did not use HRT,” Matthew Anson, PhD, clinical research fellow at the University of Liverpool and University Hospitals of Liverpool Group in the United Kingdom, and lead author of this study said in a press release.
“However, given increased risks with oral HRT, we propose that women with type 2 diabetes should not be prescribed oral estrogen therapy,” Anson added.
Medical News Today spoke with Jennifer Cheng, DO, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center in New Jersey, about this study.
Cheng, who was not involved in this research, said that she found the study promising and that it highlights the need to recognize patients who may benefit from HRT or, on the contrary, whom this therapy may place at higher risk of certain health complications.
“We need to consider carefully especially since women with type 2 diabetes may develop cardiac disease at high rates and do not have the typical symptoms for heart attacks,” she explained. “Mitigating the risks would be welcome in these patients.”
“The oral versus transdermal route of administration shows that patients with pre-existing cardiovascular risk may have higher risk for pulmonary embolism and ischemic heart disease in patients with diabetes. It provides evidence of avoiding oral estrogens in women with diabetes with higher risk as compared to the transdermal.”
– Jennifer Cheng, DO
“It is promising for patients receiving transdermal HRT having a reduced risk of ischemic heart disease without increased risk of stroke or blood clots,” Cheng added.
“Women with diabetes are concerned about cardiovascular risks since diabetes is cardiovascular risk equivalent — [meaning there is an] increased risk of heart disease. The study provides positive data that shows that we can treat menopausal symptoms with transdermal HRT without increased vascular risk, and potentially having cardiac benefits.”
MNT also spoke with Sherry Ross, MD, a board-certified OB/GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, about this research.
“With over 100 disruptive symptoms of menopause, hormone therapy can change a person’s quality of life,” Ross, who was not involved in the study, said.
“Women with type 2 diabetes must be counseled on the increased risks of pulmonary embolism, deep vein thrombosis, heart disease, and stroke when using hormone therapy. As a doctor, it is our responsibility to ensure those with type 2 diabetes use the transdermal form of estrogen to decrease these dangerous risks associated with hormone therapy, compared to those taking oral estrogen,” Ross advised.
“There simply has not been enough research done on menopause and the safety profiles for women using hormone therapy, especially those with other medical complications,” she continued.
“The importance of this research cannot be overemphasized, especially for those with ongoing medical conditions, and how the form of hormone therapy can potentially layer in additional health risks. Since heart disease is the number one killer of women, minimizing additional risks should be our top priority.”
– Sherry Ross, MD
“Larger sized, prospective studies, would help find other potential cardiovascular risks associated with different forms of hormone therapy used,” Ross added. “There are many associated risks for heart disease, so separating out some of these common risk factors would help to understand the relationship between type 2 diabetes and hormone therapy formulations used to treat the disruptive symptoms of menopause.”