Hormone Replacement Therapy And Heart Disease Risk

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Menopause can be maddening for many women, what with frequent hot flashes, sleep disturbances and even painful sex. For some women, symptoms are so intense that the transition to a life without periods dramatically impacts their quality of life.

While hormone replacement therapy (HRT) is remarkably effective at silencing such annoyances, the highly publicized link between HRT and an increased risk of heart disease, blood clots and stroke still have many women worried.

In 2002, researchers halted the Women’s Health Initiative (WHI) study after uncovering an increased risk of cardiovascular disease among a subset of women using HRT.

“Initially researchers believed that HRT (using a combination of estrogen and progesterone) reduced the risk of heart disease while also preserving bone health,” explains my colleague Adnan Munkarah, M.D., a board-certified gynecologist who leads the Department of Women’s Health Services at Henry Ford Health System. “The WHI study flipped that conventional belief upside down.”

But that one study didn’t tell the whole story. More recent research suggests HRT isn’t the big ogre women perceive it to be. In fact, some studies suggest taking HRT for a short period at the beginning of menopause may have beneficial effects, including a lower risk of certain forms of cancer and heart disease. This difference in outcomes may be partially explained by better underlying medical therapy for established heart disease or known risk factors for heart disease since the initial hormone trials 20-30years ago. Perhaps that’s one reason behind the uptick in menopausal women initiating short-term therapy.

Still squeamish about taking supplemental hormones? You’re in good company. A growing number of women are seeking relief from bioidentical hormones, herbal supplements and even simple lifestyle strategies—each with variable levels of efficacy. Before you begin a treatment regimen, consult with your doctor about all of your options. Among the most popular:

  • Traditional HRT: Usually a combination of estrogen and progesterone, HRT “replaces” the hormones your body no longer makes due to menopause. Studies show HRT not only effectively diminishes menopausal symptoms it may also protect your bones. Nevertheless, it comes with risks, and age makes a big difference. “Women in their 60s, particularly those who have signs of heart disease or hardened arteries, may be at increased risk for heart complications,” says Dr. Munkarah. Your best bet: take the lowest dose you need (for the shortest amount of time) to get relief.
  • Bioidentical Hormones: Like traditional HRT, bioidentical hormones are manufactured in a laboratory. Bioidenticals rely on compounds found in plants (mainly soybeans and wild yams) to relieve menopausal symptoms. Supporters claim the plant-based hormone’s structure is identical to the estrogen, progesterone and androgens your body makes naturally (though research has yet to confirm this theory). The U.S. Food and Drug Administration (FDA) has approved several bioidentical hormones, including the topical drug Estrace. But, many women think they can only get bioidentical hormones through a “And while compounded bioidentical hormones may be derived from natural sources, they don’t undergo the same scientific scrutiny as their FDA-approved counterparts,” says Dr. Munkarah, “and they may carry the same cancer and heart disease risks as traditional HRT.”
  • Herbal Supplements: Unlike prescription or over-the-counter medications, dietary supplements do not need to be approved by the FDA. Instead, manufacturers are free to sell products with “claims” of safety and effectiveness. “We’ve only been collecting data on these products for 10-15 years compared to more than 60 years for traditional HRT,” explains Dr. Munkarah, who says the jury is still out regarding whether they provide menopausal relief. Some studies suggest supplements including soy isoflavones, Evening Primrose Oil, Dong Quai and Black Cohosh help curb symptoms ranging from hot flashes to breast soreness and vaginal dryness while others show they offer no benefit.
  • Acupuncture: In Chinese medicine, practitioners believe inserting needles into specific pressure points affects the life energy (called qi, or “chee”) flowing through your body. Several studies show that acupuncture helps relieve menopausal symptoms, particularly hot flashes, but scientists still aren’t clear how or why it works. Since the benefits are likely to outweigh the risks, it might be worth the old college try.
  • Topical Solutions: Experiencing pain with sexual intercourse? Feel a burning or sandpaper-like sensation during urination? A topical treatment may be sufficient. For these reasons, it’s important to be upfront with your doctor about which symptoms you’re suffering from. Your physician will be able to tailor treatments for maximum relief, you’ll also avoid most of the risks associated with more systemic, oral treatments.
  • Lifestyle Strategies: Whether you choose to treat or tolerate menopausal symptoms, be sure to eat well, exercise and get sufficient sleep. Then, wear layers (so you can shed them as things heat up), use a clip fan for your bed and keep a clean nightshirt next to the bed in case you wake up in a sweat. Mindfulness practices including deep breathing, meditation and guided imagery can also be remarkably effective at managing uncomfortable symptoms. Close your eyes and picture yourself making snow angels in freshly packed powder. That alone might make you feel cooler!

No matter what bothersome symptoms are getting you down, keep in mind that menopause is a transitional time—and whatever therapy you choose, you don’t have to be on it for life. “After a few months, or even a couple of years, many women can taper down the dose without compromising their quality of life,” says Dr. Munkarah.


For an appointment or to find a doctor or certified nurse midwife specializing in menopause, visit henryford.com or call 1-800-HENRYFORD (436-7936).

The Henry Ford Women’s Heart Center is designed to provide life-changing support to women with heart disease or cardiovascular risk factors. Learn more about how a comprehensive Lifestyle Enhancement Visit may help you or call (313) 876-4540 to make an appointment.

Categories: FeelWell