Hormone replacement therapy and your heart

Long-term hormone replacement therapy used to be a routine part of medical care for postmenopausal women. Many women welcomed hormone replacement therapy because it relieves hot flashes and other menopause symptoms.

Hormone replacement therapy was also thought to reduce the risk of heart disease. Around the world, women have a lower risk of heart disease than do men. As women age, though, their heart risk increases, a change that coincides with declining levels of estrogen after menopause. In the 1980s and 1990s, experts advised older women to take estrogen and other hormones as pharmaceuticals in order to retain premenopausal heart health.

It made sense theoretically, but in practice hormone replacement therapy — or hormone therapy, as it's now called — has had mixed results. Many of the hoped-for benefits simply failed to materialize for large numbers of women. The largest randomized, controlled trial to date actually found a slight increase in heart disease, blood clots and strokes in postmenopausal women using hormone therapy.

Risks in perspective

Small as these increases in cardiovascular risks may be, they are not trivial to individual women. But neither are menopause symptoms, for which hormone therapy remains the most effective treatment.

If you're having a tough time with symptoms of menopause but worry about how hormone replacement therapy will affect your heart, try to put your personal risk into perspective. Consider these points:

• The absolute risk of heart disease to an individual woman taking hormone replacement therapy — now called hormone therapy — is quite low. If you experience moderate to severe hot flashes and other menopausal symptoms, the benefits of hormone therapy may outweigh your potential risks.
• Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle choices. Talk to your doctor about your personal risks. They may not be significant enough to preclude hormone therapy for menopause symptoms.
• If you stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure), you have a different set of health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease (CHD). And hormone therapy appears to reduce the risk of CHD when started soon after menopause in young women.

If you already have heart disease or you have a history of blood clots, proceed with caution. Work with your doctor to find the safest, most effective treatment for your menopause symptoms.

How to limit the risks

• Start hormone therapy early. Hormone therapy doesn't appear to significantly increase the risk of heart disease risk in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.
• Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms.
• Try a form of hormone therapy with limited systemic effects. Estrogen and progestin are available in many forms, including pills, skin patches, gels, vaginal creams, and slow-releasing suppositories or rings that you place in your vagina. If your most bothersome symptoms are vaginal, treatments that are administered locally — such as a vaginal cream, ring or tablet — will minimize the amount of hormones that are absorbed into your bloodstream.
• Make healthy lifestyle changes. Counter the risks of hormone therapy by making heart-healthy lifestyle changes. Don't smoke or use tobacco products. Get regular physical activity. Eat a healthy diet focusing on fruits, vegetables, whole grains and low-fat protein. Maintain a healthy weight. And get regular health screenings to check your blood pressure and cholesterol levels to detect early signs of heart disease.

A balancing act

Women of all ages should take heart disease seriously. Among U.S. women, 1 in 4 deaths each year is due to heart disease.

At the same time, most women can safely take short-term hormone therapy for menopausal symptoms without significantly increasing the risk of heart disease. If you experience severe vaginal symptoms or wake up at night with hot flashes, don't avoid hormone therapy for fear of its risks. Instead, talk to your doctor about how you can relieve troublesome symptoms while protecting your heart.

It's also still possible that hormone therapy confers some protection from heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.

Related

• Belly fat in women: Taking — and keeping — it off
• Fitness tips for menopause: Why fitness counts
• Diabetes and menopause: A twin challenge
• Bleeding after menopause: Is it normal?
• Bioidentical hormones: Are they safer?
• Testosterone therapy in women: Does it boost sex drive?
• Hormone replacement therapy: Cause of vaginal bleeding?
• Osteoporosis
• Vaginal atrophy
• Hormone therapy: Is it right for you?
• Menopause
• Hot flashes
• Perimenopause
• Menopause weight gain: Stop the middle age spread