HRT Increases Stroke Risk

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Liu noted that older women are at an increased risk of stroke due to their age, whether or not they are taking HRT.

In addition, higher doses of estrogen were associated with an increased risk for stroke, Grodstein's group found. In fact, women taking high doses of estrogen increased their risk of stroke by 62 percent.

"In summary, our findings in the Nurses' Health Study indicate that hormone therapy is associated with an increased risk of stroke, regardless of the hormone regime or the timing of hormone therapy initiation," the researchers concluded. "However, in younger women, who are at lower absolute risk of stroke, the attributable risk of stroke owing to hormone use is modest, and our data suggest that risk might be further minimized by lower doses and shorter duration of treatment."

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Liu noted that HRT is given differently than it was in 1976. "The doses we're using now are much, much lower," he said.

"The advice to women is, if you are on HRT, you should be on the lowest dose that will control your symptoms," Liu said. "In addition, you should be monitored and evaluated, and if you are going to continue on it; you need to understand what the risks are."

Another expert thinks only women with the most severe symptoms should start HRT, and then only at the lowest dose.

"You don't really see an increased risk of stroke with the lowest estrogen does," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "This study confirms that you should be on hormone replacement therapy for the shortest time possible at the lowest dose."

Wu thinks only women with the most severe menopausal symptoms who can't function well on a daily basis should start HRT. "We try to start [on] the lowest dose possible and decrease that dose even further, if possible," she said. "We keep them on a low dose for six months, and then take them off and see how they do."

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