The Heart Truth - Lower Heart Disease Risk

Menopausal Hormone Therapy and Heart Disease

Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. But beginning in July 2002, findings emerged from clinical trials that showed this was not so. In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke. The findings come from the Women's Health Initiative (WHI), launched in 1991 to test ways to prevent a number of medical disorders in postmenopausal women. It consists of a set of clinical studies on hormone therapy, diet modification, and calcium and vitamin D supplements; an observational study; and a community prevention study.

The two hormone therapy clinical studies were both stopped early because of serious risks and the failure to prevent heart disease. Briefly, the estrogen-plus-progestin therapy increased women's risk for heart attacks, stroke, blood clots, and breast cancer. These risks diminished after stopping estrogen-plus-progestin. Estrogen-plus-progestin also doubled the risk of dementia and did not protect women against memory loss. However, the therapy had some benefits: It reduced the risk for colorectal cancer and bone fractures. Estrogen-alone therapy increased the risk for stroke and venous thrombosis (blood clot, usually in one of the deep veins of the legs). It had no effect on heart disease and colorectal cancer, and an uncertain effect on breast cancer. Estrogen alone gave no protection against memory loss, and there were more cases of dementia in those who took the therapy than those on the placebo, although the increase was not statistically significant. Estrogen alone reduced the risk for bone fractures.

While questions remain, the findings make possible some advice about using hormone therapy: Estrogen alone or with progestin should not be used to prevent heart disease. Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.

• If you are considering using menopausal hormone therapy to prevent osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer. Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.

• Do not take menopausal hormone therapy to prevent dementia or memory loss.

• If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you. WHI findings confirm that menopausal hormone therapy relieves menopausal symptoms. At the average age of menopause the absolute risks (numbers) of heart attack, stroke, and blood clots are low and little affected by short-term menopausal hormone therapy. The current U.S. Food and Drug Administration recommendation for menopausal hormone therapy is that it should be used at the lowest dose for the shortest period of time to reach treatment goals.

• And remember: Your risk for heart disease, stroke, osteoporosis, and other conditions may change as you age. So review your health regularly with your doctor. New treatments that are safe and effective may become available. Stay informed.

If You Have Heart Disease: Menopausal hormone therapy was once thought to lower the risk of heart attack and stroke for women with heart disease. But research now shows that women with heart disease should not take it. Menopausal hormone therapy can involve the use of estrogen alone or estrogen plus progestin. For women with heart disease, estrogen alone will not prevent heart attacks, and estrogen plus progestin increases the risk for heart attack during the first few years of use. Estrogen plus progestin also increases the risk for blood clots, stroke, and breast cancer.

Last Updated: February 29, 2012