Estrogen Replacement Therapy and Your Stroke Risk

Does Estrogen Increase of Decrease Your Stroke Risk?

Women who experience symptoms of estrogen deficiency and who also have low estrogen hormone levels might get a prescription for estrogen replacement therapy. More often than not, estrogen therapy is used during the postmenopausal years, although some medical conditions may cause women to have low estrogen levels prior to menopause and some medical conditions contribute to early menopause.

Sometimes, children and adolescents who are taking puberty-blocking hormones as a part of gender reassignment are also given estrogen to promote sexual maturation.

You may have already heard that the interaction between estrogen replacement therapy and stroke is quite complicated. Find out what this means for you.

Estrogen Replacement Therapy

Estrogen replacement therapy or estrogen containing medical treatments can come in a variety of forms and routes of administration including cream, pill, and absorptive or even injectable form. Estrogen replacement has been shown to reduce the symptoms of estrogen deficiency for some women, but there are a few side effects and risks involved.

What Does Estrogen Have to do With Stroke?

Women tend to have a higher risk of stroke after menopause, and it is believed that this is due to changes in hormone production after menopause, including a natural age-related decline in estrogen levels.

Estrogen in Stroke Protection

A research study examining the health records of women in Finland who were taking hormonal therapy containing estrogen reported a significant decrease in stroke death among the women who took hormonal therapy containing estrogen compared to women who weren’t taking estrogen.

This finding was consistent among women who started taking estrogen therapy before the age of 60 and in women who started taking estrogen therapy after the age of 60.

Estrogen as a Cause of Stroke

But a larger study established that estrogen use has been linked to stroke. According to a recent article published by The Seminars in Reproductive Medicine, a study conducted by the Women’s Health Initiative found that women taking estrogen either alone or in combination with other hormones experienced up to a 50% increased risk of ischemic stroke. Because estrogen has been shown to increase the risk of blood clots, which can lead to ischemic stroke, this is a possible explanation for these findings.

What Does This Mean for You?

Given the confusing facts out there, what should a woman do about estrogen replacement therapy? First of all, estrogen hormone replacement therapy requires a doctor's prescription. If you experience the symptoms of low estrogen, such as hot flashes, night sweats, vaginal dryness or low libido, you will certainly need a medical evaluation, which will determine whether hormones are at the root of your problem and exactly which hormones are imbalanced. Depending on your hormone test results combined with your medical history, including your history of blood clots, stroke, hypertension or heart disease, and your smoking status you may or may not be a candidate for one of the types of estrogen therapy.

Overall, analyses from the World Health Organization show that, for younger women (50 - 59) who are within 5 - 10 years of menopause it appears safe to take estrogen therapy for up to 5 years without a significant increase in stroke risk. 

If you begin taking estrogen therapy, it is important to stay on top of all of your medical appointments, because your hormone therapy dose may need to be adjusted. Your own body’s naturally produced hormones, especially sex hormones such as estrogen and testosterone, re-adapt depending on the body's needs. This means that your own estrogen production will change depending on how much of the hormone is present in the body- either taken as a prescription or naturally made by your body.

So the dose you may initially require may not be the same as the dose you need after 1 year, 2 years or 5 years after starting on the medication.

Hormones such as estrogen certainty can have effects that reach beyond the scope of intended target. Estrogen therapy and hormonal therapy for women can impact a woman's risk of stroke. Not everyone is the same, and your medical history determines whether estrogen therapy would be helpful or harmful for you.


Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality, Mikkola TS, Tuomikoski P, Lyytinen H, Korhonen P, Hoti F, Vattulainen P, Gissler M, Ylikorkala O, Menopause, March 2015

Stroke findings in the Women's Health Initiative, Wassertheil-Smoller S, Kaplan RC, Salazar CR, Seminars in Reproductive Medicine, November 2014

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