Menopause, Hormone Replacement Therapy, and Your Heart

We call medications that doctors use to replace hormones that your body no longer produces properly after menopause, ‘Hormone therapy’ or ‘Hormone Replacement Therapy’ – you may recognize the acronym, HRT.

Doctors use estrogen, progestin, and sometimes testosterone in these medications to help lessen the symptoms of menopause. However, while there are some benefits to hormone therapy, there are also some risks.

What is Menopause?

Typically, women go through menopause between the ages of 45-55 years old. During this process a woman’s ovaries stop making eggs and her body produces less hormones.

The decline in these hormone levels results in menopausal symptoms such as, hot flashes, night sweats, vaginal dryness, mood swings, irregular heartbeat, insomnia, as well as a variety of other symptoms.

Benefits of Hormone Replacement Therapy

Hormone therapy can be in the form of a pill, patch, injection, vaginal cream, tablet, or ring. These forms of medication are divided into two categories; systemic hormone therapy and low-dose vaginal products.

• Systemic estrogen hormone therapy, according to the Mayo Clinic, is the most effective at treating menopausal symptoms such as night sweats and hot flashes. Systemic estrogen hormone therapy can also prevent vaginal dryness, itching, burning, and pain during intercourse.
• Low-dose vaginal products are another category of hormone therapy. These products minimize the amount of hormones that you absorb into your body. This low-dose medication can treat vaginal symptoms – but cannot treat night sweats or hot flashes.

Hormone Therapy and your Heart

Before a woman goes through menopause, she has a lower risk of heart disease than a man; however, as a woman ages, and goes through menopause, her estrogen levels decrease and her risk of heart disease increases.

In the 1980’s and 1990’s doctors recommended women to take estrogen and other hormones to keep their hearts healthy after menopause. However, multiple clinical trials discovered that taking hormone therapy did not reduce a woman’s risk for heart disease.

The Women’s Health Initiative (WHI) conducted a study to evaluate the risks associated with hormone therapy and women. The study included over 160,000 women, part of the group of women were taking estrogen and progestin and another group of women were taking estrogen only. However, in 2002 the National Institute of Health (NIH) stopped the part of the study where women were taking estrogen and progestin, as early data showed that hormone therapy significantly increased a woman’s risk for breast cancer, heart attack, stroke, and blood clots in the legs and lungs.

Then in 2004 the NIH halted the other group of women who had a hysterectomy and were taking an estrogen only hormone therapy. The early data on this group showed an increase in risk of blood clots and strokes and no reduction in the risk of heart attacks.

Women Who Should Consider Hormone Therapy

There are some cases where doctors may still advise taking systemic hormone therapy, as it is still the most effective treatment for menopausal symptoms, according to the Mayo Clinic. Those who may benefit from hormone therapy include women who:

• are experiencing moderate to severe hot flashes
• have osteoporosis and other treatments are not working
• have stopped having their menstrual cycle before the age of 40
• ovaries have stopped functioning normally before the age of 40

Women who have had their ovaries removed or went through early menopause should talk to their doctor about taking hormone therapy. The Mayo Clinic tells us that if these women don’t use hormone therapy until they turn 45, then they actually increase their risk for osteoporosis, coronary artery disease, earlier death, Parkinson-like symptoms, dementia, anxiety, depression, and concerns about sexual function.

Hormone Therapy Recommendations

The American Heart Association and the U.S. Food and Drug Administration have set forth new recommendations for hormone therapy:

1. HT should not be used for prevention of heart attack or stroke.
2. Use of HT for other problems such as preventing osteoporosis should be carefully considered and the risks weighed against the benefits. Women who have existing coronary artery disease should consider other options.
3. HT may be used short-term to treat menopausal symptoms.
4. Long-term use is discouraged because the risk for heart attack, stroke and breast cancer increases the longer HT is used.

Keep Your Heart Healthy

The risks associated with hormone therapy will vary depending on your medical history, the combination of hormones that are used, the dosage, your age at menopause, cardiovascular risks, cancer risks, and your family history. When deciding what is right for you, talk with your doctor about the risks and benefits and how your own unique medical history comes into play.

© Copyright 2015 Janelle Vaesa, MPH, All rights Reserved. Written For: Decoded Science