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Hormone Therapy and Your Heart

For years, post-menopausal women were advised that hormone replacement therapy (HRT) could potentially reduce their risk of developing heart disease. In addition, HRT -- synthetic hormones designed to replace those no longer made naturally by the ovaries -- was once a standard treatment for women suffering from hot flashes and other symptoms during menopause.

Since the publication in recent years of several new studies, all that has changed.

New Data Raises Doubts

No Indication for Heart Disease

"There is no indication to prescribe hormone replacement therapy for the prevention or treatment of heart disease," says Dr. Loryn S. Feinberg, a cardiologist at the  CardioVascular Institute at Beth Israel Deaconess Medical Center and medical director of the Women's Cardiovascular Program

The first study, known as HERS (Heart and Estrogen/Progesterone Replacement), failed to confirm the widely held belief that hormone replacement therapy was beneficial in protecting the heart. The study looked at the rate of recurrent heart problems in women who already had heart disease.

Increased Risk

Another study, a major clinical trial called the Women's Health Initiative, (WHI) showed that combination estrogen/progesterone therapy in healthy post-menopausal healthy women actually led to a small increase in the risk of developing  coronary artery disease and stroke. Taking estrogen alone was not found to increase risk, but had no benefit in preventing heart disease.

Impact May Vary By Age

Risk for Older Women

A more recent follow-up WHI study suggested that increased risk with combination HRT occurred in older, but not in younger post-menopausal women. There was even a suggestion of a protective effect in the younger women, those aged 50-59, who took estrogen alone, without the addition of progesterone.

"The theory is that older women (those over age 60) are further away from menopause," says Feinberg. "They already have had the chance for plaque or cholesterol to build up in their coronary arteries. The estrogen may cause inflammation and blood clots to occur around these abnormal areas."

Not Enough Evidence

At the same time, she says, the younger women are presumed to have normal, smooth arteries. "The effect of estrogen on normal arteries is believed to be possibly beneficial," she says. Still, there is not enough evidence to suggest that younger post-menopausal women should be prescribed HRT to prevent coronary artery disease, Dr. Feinberg says.

Controlling Symptoms of Menopause

Individual Decision

Some younger women may want to take HRT to control menopausal symptoms, nonetheless, she notes. "If a woman has significant symptoms related to menopause and is under 60 years of age, it is reasonable to treat her with HRT for a period of time necessary to control symptoms," Feinberg says. "This decision should be made by the woman's health care provider and the patient herself."

Lowest Dose, Least Time

She concludes: "In general, peri- or post-menopausal women with moderate to severe symptoms related to menopause should be prescribed HRT at the lowest possible effective dose to relieve symptoms and for the shortest period of time, preferably for less than five years. If a cardiac event occurs while on HRT, therapy should be discontinued."

Contact Information

Women's Cardiovascular Health Program
CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215