Hormone replacement therapy and thrombotic risk: beauty is only skin deep

In their meta-analysis of studies on hormone replacement therapy (HRT), Canonico and colleagues reported that the risk of venous thrombosis was increased by 2.5-fold in current users of oral preparations, while the risk was not increased in those using transdermal hormone patches. Several large trials have shown that oral estrogens do not protect against, and might even increase the risk of, coronary heart disease, and slightly elevates the risk of breast cancer after prolonged use. On the basis of these results, HRT is no longer indicated for long-term use. Canonico et al.'s meta-analysis shows that when used over a short period of time to alleviate the symptoms of menopause, skin patches are likely to be safer than orally-administered hormones with respect to the risk of venous thrombosis, which is a potentially fatal complication.