@jlam1950
https://link.springer.com/article/10.1186/s12905-023-02788-0
Meta analysis 2024
“ Compared with placebo (or no treatment), MHT was significantly associated with the risk of stroke in the overall population of postmenopausal women”
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.122.061559
2023. This article has is an excellent source for the history of the various large studies that guided treatment use. I have enclosed a few quotes. Please also note in the image, which is from this study, recognizes TIA as high risk for HRT

“ It is appropriate that no medical societies currently recommend HT for the primary or secondary prevention of cardiovascular disease (CVD”

“ Two decades later, in 1998, the HERS trial, the first randomized trial of EPT versus placebo for the secondary prevention of coronary heart disease (CHD) events among postmenopausal women with established CHD, found no overall cardiovascular benefit and a pattern of an early increase in CHD events with HT use, arguing against the initiation of HT for secondary prevention of CHD.5 The HERS data led to a slight reduction in HT-prescribing rates after its publication, but the early termination of the landmark Women’s Health Initiative (WHI) EPT trial in 2002, a primary prevention trial,6,7 led to a dramatic decline in the use of HT worldwide”
“ The WHI randomized trial enrolled women without CVD between 50 and 79 years of age and represents the largest randomized placebo-controlled trial of systemic HT designed to evaluate the risks and benefits for the primary prevention of chronic diseases, including CVD.6,7 Women with a uterus were randomly assigned to continuous combined oral CEE with medroxyprogesterone acetate (MPA; CEE+MPA) or placebo, and women without a uterus were randomly assigned to CEE alone or placebo. The initial publications that detailed WHI findings in 2002 (CEE+MPA) and 2004 (CEE alone), with a median age of 63.2 and 63.6 years at the time of enrollment, respectively, aggregated participants of all ages, and reported that compared with placebo, risks of CHD, stroke, and venous thromboembolism (VTE), including pulmonary embolism, were increased with HT”

“ Expert opinion suggests that it is reasonable to lower the dose of HT or discontinue HT after several years of use”

“ The WHI clinical trials found that women with metabolic syndrome randomly assigned to CEE+MPA and CEE alone compared with placebo, had a 2-fold increased CVD risk”
https://www.frontiersin.org/journals/rehabilitation-sciences/articles/10.3389/fresc.2022.825147/full
A review article 2022
“ late post-menopausal women (i.e., >10 years since menopause onset), there was no change in CVD risk and mortality with HT, though there was an increased risk of stroke and venous thromboembolism “
https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.121.038659
2022
“women exposed to HRT had a significant higher rate of ischemic stroke (HR, 1.12 [95% CI, 1.01–1.24]”

“ The increased hazard rate remained significant only for any stroke during remaining years of exposure (HR, 1.18 [95% CI, 1.05–1.32]; Table S8; Figure 2B). After discontinuation, women who had been exposed to HRT continued to have a higher hazard rate of any stroke (HR, 1.16 [95% CI, 1.02–1.32]). These results were similar when including blood pressure in the model”

“ We have shown that both OC use and oral HRT is associated with an increased risk of any stroke,”

“ We found an ≈20% increased event rate of any stroke among women who had ever initiated HRT. This estimate is slightly lower than those reported from the WHI (Women’s Health Initiative) trials,17,32,33 and observational studies18 (30%–40%). However, the WHI trial only covered a selected population of postmenopausal women within a specific age range (50–79 years),34 as compared with our participants’ age range at recruitment (37–73 years). Our study included a longer follow-up time and a longer duration of average use, and our estimates are therefore weighted toward a long-term effect as compared with the WHI. When we analyzed stroke subtypes, an increased risk of stroke was observed also for subarachnoid hemorrhage. This adds to previous knowledge, where the risk of subarachnoid hemorrhage in previous studies has not been possible to evaluate due to limited power.17,18 This has not only clinical significance but also gives new insights on a possible additional mechanism of exogenous hormones, given the important differences in the pathogenesis of stroke subtypes, especially ischemic and hemorrhage.”

“ In our study, we observed an increased risk among previous HRT users compared with nonusers. This could be a result of sudden estrogen withdrawal, which may cause vasoconstriction and potentially trigger stroke events in women at high risk of stroke, as the vasodilatory effects of estrogen abruptly drop.38,39 However, it is also possible that atherosclerotic lesions are built up during treatment as a result of various processes, including elevated C-reactive protein levels during HRT use,40 and that these lesions remain and result in higher stroke risk persisting also after discontinuation”

“ Our findings indicate that HRT is associated with an increased risk of stroke, regardless of the timing of initiation or duration.”

Of note this is just from the first page of studies, of which there were very many