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Does combination hormone replacement therapy prevent heart disease?

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You wake up one morning and you’re fine. The next morning, a very unwelcome guest has strong-armed its way into your life bringing night sweats, mood swings, a belly the likes of which you haven’t seen since you were pregnant, along with a vague feeling of disorientation as you wonder what just hit you.

Welcome or not, menopause is a fact of life and it’s going to happen to all women eventually. In addition to the pesky menopausal side effects that we can see and feel, it also leaves us an unwelcome gift that we can’t see, an increased risk of heart disease.

As if the gifts of menopause weren’t enough, being postmenopausal is a risk factor for developing cardiovascular disease.

Menopause is one stage in life for which there is no one-stop-shopping of treatment. Each woman responds differently to the changes in her body.

Some experience rather mild symptoms which can be controlled by herbal supplements, dietary or lifestyle changes. Other women get hit by symptoms so severe that it rivals a F5 tornado and leaves them wondering it they’ll ever be able to dig themselves out from the wreckage. For those women, herbal supplements and lifestyle changes may not be enough to address what is happening.

Regardless of the severity of the symptoms, we all have one thing in common. Menopause increases our risk of heart disease. As if to add insult to injury, research indicates that some of the therapies which are commonly used to treat menopause symptoms may also significantly increase your risk of heart disease above and beyond the risk brought by menopause itself.

It’s important for women who are now at that ‘certain age’ to understand not only how menopause impacts their heart health, but how some of the common treatments for menopause may impact their heart health as well.

The Women’s Health Initiative (WHI) is an ongoing 15-year research program that focuses on improving the quality of life in postmenopausal women. Specifically, the WHI focuses on heart disease, cancer and osteoporosis in postmenopausal women. These are the three most common causes of either death or disability for postmenopausal women.

The WHI recently released findings from two separate studies related to combination (estrogen and progestin) hormone therapy usage in postmenopausal women. The news, with respect to heart health, was not good for women who currently take or may be considering combination hormone replacement therapy for menopause.

The WHI studies tracked 27,347 participants. All participants were women, postmenopausal and still had a uterus intact. One of the key answers being sought by these studies was whether or not combination hormone replacement therapy would reduce the risk of heart disease.

The net was that researchers found more long-term risks than benefits associated with combination hormone replacement therapy. The trials were actually stopped because of those increased risks. It should be noted that these studies were focused on women taking combination therapy and not those taking estrogen only as hormone replacement therapy.

During the course of the study, researchers found that combination hormone replacement therapy actually increased the risk of developing heart disease by 29% in postmenopausal women. Two particular groups of women seemed to be most affected in terms of increased risk of heart disease:

• Postmenopausal for less than 10 years. Women in this group were found to have an increased risk of developing heart disease, particularly within the first two years of starting hormone replacement therapy. The results were more than double that of their counterparts.

• Postmenopausal for more than 10 years. Women in this group who began combination hormone replacement therapy were also found to have a greater risk of heart disease (three times more) in the first two years of starting therapy as compared to others.

The increase in the risk of developing heart disease was consistent regardless of the age of the participants. In addition to an increased risk of developing heart disease, participants on combination hormone replacement therapy also saw an increase in strokes and blood clots.

The most disappointing news was that researchers found long term, postmenopausal women on combination hormone replacement therapy were 69 percent more likely to develop heart disease than their counterparts (who were not on combination hormone replacement therapy)!

So, what does all this mean? It means that women who are postmenopausal have special heart health considerations. Before beginning any hormone replacement therapy regime, you should discuss your heart health and the risks that hormone replacement therapy may introduce.

Frankly, this is a discussion that all postmenopausal women should have with their doctors simply because menopause alone introduces an increased risk of heart disease. Heart disease, even for the postmenopausal woman, is still preventable so have the heart discussion with your doctor!

Until next time, here's wishing you a healthy heart.

Sources:
Heart Diseases – Prevention, National Heart Lung and Blood Institute, 01 Feb 2010, http://www.nlm.nih.gov/medlineplus/heartdiseasesprevention.html

WHI Study Data Confirm Short-Term Heart Disease Risks of Combination Hormone Therapy for Postmenopausal Women, NIH News, U.S. Department of Health and Human Services, National Institutes of Health, 15 Feb 2010, http://www.nih.gov/news/health/feb2010/nhlbi-15.htm

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EmpowHER Guest
Anonymous

Estrogen works to regulate a woman's monthly menstrual cycle and secondary sexual characteristics such as breast development and function, and also rises at different times in the menstrual cycle to prepare the body for fertilization and reproduction. Progesterone also rises in a cyclical fashion to prepare the uterus for possible pregnancy and to prepare the breasts for lactation milk production. As a woman reaches menopause, typically around 50 years old, her body produces less and less estrogen and progesterone. It is estimated that 40 million women will reach menopause in the next 20 years.
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May 25, 2010 - 9:49pm
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