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- Hormone replacement therapy and your heart
- Hormone therapy: Is it right for you?
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Hormone replacement therapy and your heart
Are you taking — or considering — hormone therapy to treat bothersome menopausal symptoms? Understand the risks to your heart and how to minimize them.
By Mayo Clinic staffIn the 1980s and 1990s, doctors in the United States routinely recommended long-term hormone replacement therapy to postmenopausal women to treat menopausal symptoms and to prevent heart disease. In 2002, this practice stopped abruptly, when studies showed that hormone replacement therapy may actually increase the risk of heart disease rather than prevent it. Yet, hormone replacement therapy remains the most effective treatment for bothersome menopausal symptoms, such as hot flashes and vaginal dryness.
For women who are approaching — or facing — menopause, these contradictory conclusions about hormone replacement therapy can seem impossible to reconcile. 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. 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.
Hormone therapy and heart disease: What's the connection?
Around the world, women have a lower risk of heart disease than do men. Doctors and researchers have long attributed this difference to the female hormone estrogen. And they've blamed the declining levels of estrogen after menopause for the increase in heart disease as women age.
For decades, observational studies seemed to demonstrate the protective power of estrogen — not just before menopause, when your ovaries produce estrogen naturally, but also after menopause, when supplied by pills, skin patches and other preparations.
Then came the Women's Health Initiative (WHI), a large clinical trial expected to confirm the benefits of hormone therapy. Its surprise finding: Not only did postmenopausal hormones fail to protect women from heart disease — hormone therapy actually made older women more likely to have heart attacks, blood clots and strokes.
What were the results of large clinical trials on hormone therapy?
According to the WHI, for every 10,000 women taking estrogen plus progestin for one year, there would be:
- Seven more cases of heart disease
- Eight more cases of breast cancer
- Eight more cases of stroke
- 18 more cases of blood clots
For women in the study taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. But researchers did find that over one year, 10,000 women taking estrogen, compared with a placebo, might experience 12 more cases of stroke and six more cases of blood clots in the legs.
The findings of the WHI were not all bad, though. Women in the study who took combination hormone therapy experienced fewer hip and vertebral fractures than normal.
However, for most women, the exact number of blood clots and hip fractures isn't the most important information gleaned from the WHI. The key message of this study is simply that hormone therapy shouldn't be given to all women — like a vitamin — to make them live longer.
Current recommendations
Doctors no longer prescribe hormone therapy to prevent heart disease and other chronic conditions affecting postmenopausal women. Today, however, the fear of using any postmenopausal hormone therapy at all has subsided. That's partly because continuing analysis of WHI data points to a middle ground rather than an all-or-nothing approach to hormone therapy.
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.
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