we'll use a concept called "Number Needed to Harm". This means that the 1% absolute risk increase translates to "for every 100 women you treat with HRT, an additional 1 woman will get a DVT"
but this is still insignificant, as 100 women will have a significant quality of life improvements, Even the 1 that will eventually die to dvt, even she will experience those effects.
Now add in the other risks that HRT has - breast cancer and stroke. We'll assume here that they also have a 1% risk
cant imagine that hrt would affect breast cancer risk at all so long as you do it properly (and by risk i mean it'd increase it back to levels you had before you were menopausal) . in my case my ovaries have never produced much of anything - i'm on hrt, i am at no higher risk for anything whatsoever so long as i dont take oral estrogen, this is what 2 endocrionlogists have told me, as well as my GP, and i reached a similar conclusion by reading medical literature as well. So long as i do not get sick with something that would affect things, no additional risk. i'm also told i can continue (and should) taking it until i die, which is perfectly fine by me.
By contrast, the risk of DVT in an elderly individual is approximately 1% a year. A 3 times risk increase (1%>3%, 2% absolute risk increase) therefore means an additional 1 women for every 50 you treat with HRT will get a DVT. Now let's say your risk is slightly increased by a minor, common risk factor - you're an elderly woman who doesn't exercise much - so now your baseline risk is 2%. Your risk of getting a DVT on HRT is now 6% per year (or 4 more women in this demographic will get a DVT each year as a result of treating 100 women with HRT).
this is something that makes me wonder...as you age risk obviously increases, but it appears that a very large chunk of elderly (and well..everyone) is overweight or obese..thats got to affect your dvt,stroke risk and whatnot. makes me wonder if the guidelines are written with overweight patients in mind, as they are the majority. ~70% of US is overweight or obese, ~60% of UK are overweight or obese... thats not healthy in any way, So it could be that guidelines are written with such patients in mind. i doubt that any studies specifically look for Fit elderly people, they most likely simply get anyone who does not have dvt/other risk factors and test hrt on those, while ignoring that obesity itself is a risk factor (i've never once seen a study actually control for weight if it wasnt a weight-specific study... they usually dont even mention in what state the health of the patient actually is)
Is it acceptable to you that an additional 1 woman every year gets a DVT when you treat 100 women with HRT? What if another 2 women will get breast cancer if you do? But then you will also prevent 2 hip fractures for every 100 women. How do you quantify the increase in quality of life and balance it with the morbidity caused?
dvt or cancer isnt an instant death, it can be sometimes mean that you will eventually die, but it doesnt mean that you will 100% now die. also hrt isnt just physical effects like preventing osteoporosis, mental stuff too - it influences mood quite significantly. imo additional 2 women who get breastcancer from hrt is perfectly fine, simply explain them the risks and make them make a decision about what they want to do.