Risk of hormone replacement therapy in stroke patients

Hormone replacement therapy (HRT) (oestrogen with or without progestin) is often initiated with the onset of menopause to decrease symptoms of oestrogen deficiency, such as vasomotor instability (hot flashes) and urogenital effects (1-3). HRT can also prevent long-term consequences of oestrogen deficiency, such as osteoporosis and cardiovascular disease (1-3). The decision to start HRT in peri- and postmenopausal women is complicated by concerns of increased risk for thromboembolic events, uterine cancer and breast cancer (2-4). Thromboembolic stroke is a particular concern due to its association with the use of oral contraceptives with high oestrogen content (3, 4). However, for older women it has been suggested that HRT use decreases or has no effect on stroke risk (5-9). Should these findings apply to a women with a history of thromboembolism, in this case ischemic stroke?