The findings, which conclude that HRT "cannot be recommended for the primary or secondary prevention of stroke", offer further support for the use of natural remedies as an alternative to the treatment.
The review of 28 trials that included nearly 40,000 women aged between 55 to 71 years found that women who used hormone replacement had a 29 per cent higher risk of stroke than those in control groups.
"Importantly, the severity of stroke was increased with hormone replacement therapy, since the frequency of a poor functional outcome, judged as combined death and disability or dependency, was 56 per cent higher in those randomised to therapy," write Philip M. W. Bath and Laura J. Gray of the University of Nottingham, UK, in the 7 January issue of the British Medical Journal (doi:10.1136/bmj.38331.655347.8F).
The researchers recommend that "patients at high risk of stroke - such as those with previous stroke, coronary heart disease, or multiple vascular risk factors - should stop taking hormone replacement therapy unless there is a strong contrary medical reason."
Makers of soy isoflavones, shown to have some benefit on relieving menopausal symptoms, and other plant-based supplements have seen strong following the findings of HRT's serious side effects.
There have been some reports that women are going back onto hormone replacement therapy because it is significantly more effective than herbal remedies but industry says it has since little sign of flagging interest in the products.