Women with type 2 diabetes should consider switching their HRT tablets to patches to reduce their risk of potentially fatal blood clots, according to a new study.
Researchers have found women with the condition who take an oral form of HRT have double the risk of a pulmonary embolism – when a blood clot blocks an artery in the lung – than those using skin patches.
They also have a 21 per cent increased risk of heart disease, the study revealed.
And the scientists said their findings should be seriously considered by women and their doctors when deciding what form of hormone replacement therapy to take.
HRT is regularly prescribed to women suffering from the effects of menopause to relieve symptoms such as hot flushes and night sweats.
Treatments include tablets containing oestrogen only, or a combination of oestrogen and progesterone, as well as patches, gels and creams.
Between 2023 and 2024, approximately 2.6 million women in the UK were taking some form of HRT.
A team, led by researchers from the University of Liverpool, analysed data obtained from the electronic health records of more than 36,000 women on HRT who were followed for five years.
Women with type 2 diabetes who are currently taking HRT tablets (pictured – stock image) should consider switching to patches, experts said
They found a significantly higher risk of pulmonary embolism and heart disease for women with type 2 diabetes who took HRT in tablet form compared to those who used skin patches.
Lead author Dr Matthew Anson said: ‘Given increased risks with oral HRT, we propose that women with type 2 diabetes should not be prescribed oral oestrogen therapy.’
The authors suggest that the reason for the difference in risk of developing pulmonary embolism and heart disease between oral and transdermal HRT might be due to the different way oestrogen is absorbed.
When taken orally, much of the oestrogen is broken down by the liver before entering the circulation, which might impair the balance between clotting and anti-clotting proteins.
In contrast, when given in patch form, oestrogen is given in lower doses and absorbed directly through the skin and into the blood circulation.
Despite the increased risk in pulmonary embolism and heart disease, there was no difference in risk for deep vein thrombosis (DVT), stroke, or breast, ovarian or endometrial cancer between the two HRT methods.
‘The decision to use HRT, even for a short period of time, is very difficult for many women,’ said Dr Anson. ‘We hope our data will provide the increasing number of postmenopausal women living with T2D and their physicians with more evidence to consider when weighing the risks versus benefits of the most appropriate HRT formulation.’
The findings were presented at the annual meeting of the European Association for the Study of Diabetes in Vienna.
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