Menopause Hormone Therapy and Cardiovascular Disease

Menopause is a normal stage of life for women. Hormone replacement therapy with estrogen or estrogen-progesterone combination is used to relieve menopausal symptoms such as hot-flashes and night sweats. However, the effects on hormone replacement on cardiovascular disease remain controversial.

What we know so far:

Cardiovascular disease is the leading cause of mortality and morbidity in postmenopausal women and remains under-treated and under-diagnosed.
Risk factors for cardiovascular disease include hypertension (high blood pressure), high cholesterol, diabetes, smoking, sedentary lifestyle, family history of premature heart disease and obesity.
Majority of women with menopause symptoms report an improved quality of life when hormone therapy is initiated.
Estrogens can raise HDL- cholesterol (good cholesterol) and lower LDL-cholesterol (bad cholesterol) levels.
Up until the late 1990’s estrogen therapy was believed to be protective against cardiovascular disease, however Women’s health initiative trial in 2002 which found an increased risk of cardiovascular events, strokes and venous thromboembolism.
More recently, randomized clinical trials have not shown any benefit of hormone replacement therapy on cardiovascular disease risk in older women or women with already established cardiovascular disease. However, the benefits of hormone therapy depend on the timing of administration, route of administration, dosage and age.
Recent findings also show that in patients who were aged 60 years or younger and initiated hormone therapy within 10 years of menopause had a slower progression of cardiovascular disease.

What can you do:

Follow up with a preventive cardiologist if you have existing significant risk factors for cardiovascular disease (listed above) to weigh the risk vs. benefit of initiating hormone replacement therapy.
If you are currently on hormone replacement therapy and have significant risk factors for cardiovascular disease (listed above) follow up with a preventive cardiologist to evaluate risk with continuation of HRT.
Avoid smoking, engage in aerobic activity for at least 30 minutes five times per week and maintain ideal body weight.