A large nationwide case-control study from Denmark, published this month, examines associations between current use of menopausal hormone therapy (MHT) and risk of venous thromboembolism (VTE), ischaemic stroke, and myocardial infarction (MI).
MHT remains an effective and well-established treatment for menopausal symptoms, with recognised benefits for quality of life and bone health. As with all treatments, MHT carries potential risks, and this study adds further real-world evidence to support individualised prescribing decisions.
Key findings
- Using Danish national health registries, researchers followed women aged 50 to 69 with no prior history of thrombotic disease, cancer or related conditions, between 2003 and 2021.
- Oral estrogen therapy (alone or combined with progestin) was associated with increased rates of VTE, ischaemic stroke, and MI compared with no current use.
- The number needed to harm for one year of oral therapy was 1055 for VTE, 791 for venous thromboembolism, 1642 for ischaemic stroke, and 3846 for MI.
- Higher dose oral estradiol (>1 mg per day) used for more than one year was associated with increased stroke and MI risk, rising with duration of use.
- Transdermal therapy was not associated with increased thrombotic risk, with one exception: transdermal combined cyclic therapy was linked to increased MI risk.
Clinical relevance
These findings support existing guidance that route of administration is a key consideration in MHT prescribing, particularly for women with additional risk factors for VTE, stroke or MI.
Absolute risk increases associated with MHT use remain small. Individual risk-benefit discussions should take account of a woman’s full clinical history.
Read the full abstract here: https://doi.org/10.1136/bmj-2026-100688