Experts have advised women with type 2 diabetes who take HRT in tablet form to consider patch versions instead, after research highlight an increased risk in blood clots.
A study found that, compared to women with type 2 diabetes who use HRT skin patches, those with the condition who take HRT orally have double the risk of developing a pulmonary embolism, which is when a blood clot travels to the lung and blocks an artery.
This high-risk group also has a 21% greater risk of heart disease, with the team behind the findings urging women to speak to their doctor about the risks before deciding on a HRT pathway.
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Lead author Dr Matthew Anson, from the University of Liverpool, said: “Given increased risks with oral HRT, we propose that women with type 2 diabetes should not be prescribed oral oestrogen therapy.
“The decision to use HRT, even for a short period of time, is very difficult for many women.
“We hope our data will provide the increasing number of postmenopausal women living with type 2 diabetes and their physicians with more evidence to consider when weighing the risks versus benefits of the most appropriate HRT formulation.”
HRT can be prescribed in tablet form, patches, gels and creams and is used to relieve the symptoms of menopause, which include hot flushes and night sweats.
It was estimated that around 2.6 million women in the UK were taking HRT in the period 2023 to 2024.
The study saw researchers examine the health records of just over 36,000 women on HRT over a period of five years.
The team say the difference in risk between the HRT tablets and patches could be due to the way oestrogen is absorbed.
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With tablets, most of the oestrogen is broken down by the liver which could impact the balance between clotting and anti-clotting proteins.
With patches, the oestrogen is delivered in lower doses and is absorbed directly into the blood circulation.
Looking further at the different HRT methods, the researchers found no difference in risk for deep vein thrombosis (DVT), stroke, or breast, ovarian or endometrial cancer.
