national-clinical-guidelines-for-stroke-fourth-edition

National clinical guideline for stroke
Evidence to recommendation
There is strong evidence from a meta-analysis (Farquhar et al 2009) of an increased risk
of stroke with the use of oestrogen-only and combined (oestrogen and progesterone)
hormone replacement therapy in relatively healthy women. Giving hormone therapy
must be balanced against clinical need (treatment of premature menopause or relief of
menopausal symptoms). There is limited evidence from one case control study (Renoux
et al 2010) that transdermal hormone replacement therapy may not be associated with an
increased risk of stroke and that lower doses of oestrogen have a lower risk of stroke. One
study looking at tibolone (Cummings et al 2008) was ended prematurely due to an
increased risk of stroke. Tibolone is not recommended in the use of treatment of
menopausal-related symptoms or treatment of osteoporosis in women who have had a
stroke.
5.10.1 Recommendation
5.10.2 Source
A The decision whether to start or continue hormone replacement therapy should be
discussed with the individual patient and based on an overall assessment of risk and
benefit. Consideration should be given to the dosage and formulation (eg oral or
transdermal preparations).
A Magliano et al 2006
78 © Royal College of Physicians 2012