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Hormone replacement therapy and your heart

Are you taking — or considering — hormone therapy to treat bothersome menopausal symptoms? Understand potential risks to your heart and whether hormone therapy is right for you.

By Mayo Clinic staff

Long-term hormone replacement therapy used to be routinely prescribed for postmenopausal women to relieve hot flashes and other menopause symptoms. Hormone replacement therapy was also thought to reduce the risk of heart disease.

Before menopause, women have a lower risk of heart disease than men do. But as women age, and their estrogen levels decline after menopause, their risk of heart disease increases. In the 1980s and 1990s, experts advised older women to take estrogen and other hormones to keep their hearts healthy.

However, hormone replacement therapy — or hormone therapy, as it's now called — has had mixed results. Many of the hoped-for benefits failed to materialize for large numbers of women. The largest randomized, controlled trial to date actually found an insignificant increase in heart disease in postmenopausal women using hormone therapy.

Still, some data suggest that estrogen may decrease the risk of heart disease when taken early in postmenopausal years:

  • In a recent Danish study, after 10 years of treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure or heart attack, without any apparent increase in risk of cancer or stroke.
  • A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women was recently completed, with results expected soon.

Risks in perspective

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

  • The risk of heart disease to an individual woman taking hormone therapy is very low. If you are in early menopause, have moderate to severe hot flashes and other menopausal symptoms, and are otherwise healthy, the benefits of hormone therapy likely outweigh any potential risks of heart disease.
  • Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices. Talk to your doctor about your personal risks. If you're at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration.
  • Risk differs for women with premature menopause or premature ovarian failure. 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 heart and blood vessel (cardiovascular) health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease.

Hormone therapy risks may vary depending on whether estrogen is given alone or with a progestin, and depending on your current age and age at menopause, the dose and type of estrogen, and other health risks such as your family medical history and cancer risks.

Who should not take hormone therapy

If you've already had a heart attack, hormone therapy is not for you. If you already have heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits.

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References
  1. Martin KA, et al. Postmenopausal hormone therapy: Benefits and risks. http://www.uptodate.com/index. Accessed June 19, 2012.
  2. Menopause and hormones. U.S. Food and Drug Administration. http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm. Accessed June 19, 2012.
  3. Questions and answers about the WHI postmenopausal hormone therapy trials. National Institutes of Health. http://www.nhlbi.nih.gov/whi/whi_faq.htm. Accessed June 20, 2012.
  4. Martin KA, et al. Treatment of menopausal symptoms with hormone therapy. http://www.uptodate.com/index. Accessed June 19, 2012.
  5. Ferri FF. Ferri's Clinical Advisor 2013: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-08373-7..00002-9&isbn=978-0-323-08373-7&uniqId=340669393-2. Accessed June 20, 2012.
  6. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012;19:257.
  7. Menopause. National Institute on Aging. http://www.nia.nih.gov/health/publication/menopause. Accessed June 20, 2012.
  8. Deaths: Leading causes for 2008. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_06.pdf. Accessed July 2, 2012.
  9. Kronos Early Estrogen Prevention Study (KEEPS). ClinicalTrials.gov. http://clinicaltrials.gov/ct2/show/results/NCT00154180. Accessed June 20, 2012.
  10. Martin KA, et al. Postmenopausal hormone therapy and cardiovascular risk. http://www.uptodate.com/index. Accessed June 20, 2012.
  11. Schierbeck LL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: Randomised trial. BMJ. 2012;345:e6409.
WO00131 Oct. 25, 2012

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