A major health concern for women after menopause is the risk of heart attack and stroke. Throughout the last decade, Hormone Replacement Therapy (HRT) has been used to treat menopausal symptoms and help prevent cardiovascular disease. Now, there is a large body of evidence that has shown that women who take HRT are also at a lower risk of heart disease.
In the first 5-10 years after menopause, estrogen is actually effective in preventing cardiovascular disease. It is in this group that HRT can make a difference. This concept was discovered in the first and only prospective, double blinded, placebo controlled study of HRT in older women, called the Women’s Health Initiative Study (WHI). This was a controlled study designed to test the hypothesis that HRT is beneficial in preventing heart disease in women. Primarily studied were older women, well past menopause.
Because this was such a large study, the data was analyzed by looking at many aspects of women’s health. The issue of breast cancer is paramount in women’s concerns for their immediate and long-term health. Recently, the data from the WHI showed that there was less breast cancer in the group of women who only took estrogen and not both hormones (estrogen and progesterone). However, this is not necessarily the answer. Many observational studies suggest that there is an increased risk of breast cancer when estrogen is used over a long period of time. This risk is reduced after about five years of discontinuing use. The risk of breast cancer is higher in those women who use both estrogen and progesterone daily.
The key is to speak with your health care provider in order to individualize HRT to the individual situation:
- If a woman has symptoms that are affecting the quality of her daily life at work and/or at home, there are many options for her to manage her symptoms. Some of these include better handling of stress, and avoiding hot drinks, coffee, alcohol, spicy foods and carbohydrates.
- For women who need hormone replacement and who still have their uterus, a patient specific combination of estrogen and progesterone should be considered.
- Women who do not have a uterus should not take progesterone because of the increased risk for breast cancer with daily use.
Advantages of HRT
Lower risk of cardiovascular disease (when started around the time of menopause), improvement in bone strength, symptom improvement, lower risk of colon cancer, and improved bladder and vaginal health.
Disadvantages of HRT
Increased risk of cardiovascular disease (if started well after menopause), and increased risk of breast cancer if used for an extended period of time.
Recommendation
With the help of your health care provider, use the lowest amount of estrogen and progesterone as needed to control symptoms of menopause, and stop its use when symptoms abate. Exercise, breast monitoring, and controlling alcohol intake will lower the risk of breast cancer. A healthy diet, exercise, monitoring cholesterol and not smoking will lower the risk of cardiovascular disease.