There is no reliable evidence at this time that HRT (Hormone Replacement Therapy) and other oestrogen therapies such as oral contraceptives increase future risk of cavernoma bleeding. HRT and Oral Contraceptive Pills are not contraindicated for cavernomas in the Summaries of Product Characteristics for these medications, the documents required in Europe before medicines are authorised.
A small research study published in 2020 on predictors of haemorrhage in patients with cavernoma raises the possibility of a higher risk of haemorrhage for women taking forms of oestrogen therapy (HRT or oral contraceptive). The study found that 26% of women who had bled from a cavernoma when first diagnosed were taking oestrogen compared to 12% of women with a cavernoma who had not bled at presentation. The study was not designed to say whether women who took oestrogen after diagnosis were at higher risk of future bleeding. Further research using larger cohorts is needed before making recommendations about oestrogen use and its risk for patients with cavernoma.
If you wish to consider HRT or oral contraceptives, talk to your doctor about your needs and questions. They should be aware of current recommendations and you can show them this information. At this time, there is no reliable evidence that HRT or Oral Contraceptive Pills increase future risk of cavernoma bleeding. Your doctor will take your personal medical and cavernoma history into account when considering what’s best for you.
Updated January 2022