Hormone therapy
Research looking at hormone therapy (including HRT and hormonal contraception) and bleeding from cavernoma has produced mixed results. One study suggested a possible association, while another did not find an increased risk of bleeding associated with hormone therapy use. More research is needed, and we don’t yet have clear answers.
Hormone therapy is not currently listed as unsafe for people with cavernoma. Decisions about hormone therapy should be made individually with your GP or neurologist, taking into account the potential benefits of treatment alongside the current uncertainty about any possible effect on bleeding risk.
Current evidence
Hormone therapy includes medicines used for contraception (such as the pill or contraceptive patch) and to manage menopause symptoms (hormone replacement therapy or HRT). These often contain forms of the hormones oestrogen and/or progestogen.
Two studies have looked at whether hormone therapy might be linked to bleeding from brain cavernomas in women, and they reached different conclusions. However, the studies were designed differently, which makes direct comparison difficult.
One study involving 722 women found that women using hormone therapy had a higher rate of symptomatic bleeding than women who were not using hormone therapy. A more recent study, involving a smaller number of women, did not find an increased risk of bleeding associated with hormone therapy.
The studies differed in their design and methodology. One followed a larger group of women over time, while the other involved fewer women and used existing medical records. These differences need to be considered when interpreting the findings. Both studies can identify associations, but they cannot prove that hormone therapy causes cavernoma bleeding.
Practical implications
Taken together, these studies do not provide a definitive answer about whether hormone therapy affects the risk of bleeding from a cavernoma. More research is needed to better understand this relationship.
Many healthcare professionals may not be aware of this recent research, so it may be helpful to download and print copies of the studies to bring to any appointments about hormone therapy. This can support informed decision-making with your healthcare professional.
Common questions
Does the type of hormone therapy matter?
We don’t yet have research comparing the risk of bleeding across different types of hormone therapy in people with cavernoma. This includes different doses, delivery methods (like patches, pills or implants), or whether therapy contains oestrogen alone or in combination with progestogen.
In the general population, some forms of HRT (such as patches or gels applied to the skin) are thought to carry a lower risk of stroke. However, we don’t know yet if this applies to the risk of cavernoma bleeding.
What about non-hormonal contraception?
The copper coil (IUD) is a non-hormonal contraceptive placed in the womb. Because it does not contain hormones, it is not expected to increase the risk of cavernoma bleeding, although this has not been specifically studied.
What about other hormonal contraceptives?
Other methods of contraception, like the Mirena coil (IUS) or the NuvaRing, do release hormones. Although these methods use lower doses of hormones compared to oral contraceptives, no studies have yet looked at whether they carry a lower risk of cavernoma bleeding. If you use or are considering any of these options, it’s best to speak to your GP or neurologist.
What if I’m having IVF?
IVF often involves hormone treatment. The recent study did not include enough people undergoing IVF to say whether there is any increased risk of bleeding in those with cavernoma. As with other treatments, this should be discussed with your fertility team and your GP or neurologist, who can help you consider your individual circumstances.
What if I have a spinal cavernoma?
The study focused on cavernomas in the brain, and there is currently limited evidence about whether the findings apply to spinal cavernomas. If you have a spinal cavernoma and are considering hormone therapy, discuss this with your GP or neurologist, who can help you consider your individual circumstances.
Should I stop hormone therapy?
No. You should never stop or change your medication without speaking to your doctor. If you are currently taking hormone therapy, speak to your GP or neurologist before making any changes. They can help you weigh up any possible risks and benefits based on your health history and needs.