The reputation of hormone replacement therapy took yet another knocking this morning after the results of an analysis of 28 clinical trials saying that women using HRT were at a 29% increased risk of suffering a stroke were published in the British Medical Journal.

Researchers at the University of Nottingham reviewed the evidence from trials including almost 40,000 individuals, assessing the risk of stroke by type, severity, and outcome. They also found that the severity of stroke was increased with HRT.

Although the researchers cannot definitively determine why HRT should be shown to increase stroke risk when they note other trials have suggested it exerts a protective effect, they conclude that HRT should not be recommended for the prevention of stroke.

HRT prescription rates have dropped significantly in the years since the Women’s Health Initiative Trial was halted after finding an increased risk of breast cancer and a lack of overall benefit, and the so-called Million Women Study showed a doubling of breast cancer cases amongst users of combined HRT product [[10/07/02b]], [[08/01/04f]], [[08/08/03a]]. The UK regulatory agency has since advised that the “lowest effective dose of HRT should be used for the shortest possible duration” for the treatment of menopausal symptoms [[04/12/03b]], and the Royal College of Obstetricians and Gynaecologists said that it should be used with caution and only for the sort-term relief of menopausal symptoms [[01/12/04g]].