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Heart Smart Living

Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.

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Hormone Replacement at Menopause Onset: Could it Protect the Heart?

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If you’re a woman and are concerned about your heart health, you’re probably well aware that hormone replacement therapy (HRT) for menopause is a complicated and controversial topic. Although the “change of life” has been a part of life since Adam and Eve, medical science only began taking the issue seriously in the past two decades.

For a quick update on what’s been going on with HRT research in recent years, click here. The question that has continued to dog scientists, gynecologists, primary care physicians, and cardiologists has been this: Who stands to benefit from HRT, and who might it harm? The question is more complicated than it seems, because, like all drugs, there are risks as well as benefits. For HRT, those risks include heart attacks, strokes, blood clots, gallstones, and other potentially serious problems. The clear benefits are reduction (or elimination) of menopausal symptoms like hot flashes and insomnia, improvement in vaginal dryness, and increased bone strength.

Some studies also have suggested that even though heart attack risk may rise overall, for some women who have recently entered menopause, there may actually be heart protection. This has been called the “timing hypothesis.”

Most women know from personal experience that “one size fits all” is a myth. The same holds true for HRT. Ideally, we should be able to identify those who stand to gain the most benefit at the lowest risk. There is no question that women who are more than five years out from menopause are at the highest risk for complications, but what about women who are just beginning menopause? A new study from researchers in Copenhagen, Denmark helps to shed more light on the issue.

In this study, over 1000 healthy women ages 45-58 who had only recently started menopause were given either HRT or a placebo pill. (In keeping with standard medical practices, women who still had their uterus received estrogen plus progesterone, in order to protect against uterine cancer, while those who had undergone hysterectomy received estrogen alone).The study went on for 11 years, although the women were followed for another five years.

After ten years, those women who received HRT were half as likely to have suffered a heart attack or to have died, while the incidence of cancer did not differ between the groups. There was no significant difference in strokes or blood clots. At 16 years, the HRT group still came out ahead.

Unlike many other studies, the women in this group received 17-beta-estradiol (similar to our own natural estrogen), and not Premarin (which is made from horse urine). Whether or not this made a difference could not be addressed, but smaller studies have suggested that Premarin is associated with more complications.

How to use this information? If you are experiencing menopause in its early stages, HRT may not be taboo after all. Discuss your personal risks and benefits with your physicians, taking into account your risk factors for heart disease and cancer, and the severity of your menopausal symptoms.

No matter what option you take, choosing a healthy lifestyle, regular exercise, and a heart smart diet will help to protect you from cardiovascular disease, and reduce your risk for cancer.

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Tags: Women and Heart Health

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About the Author


MD, FACC

Dr. Samaan is an acclaimed cardiologist, writer, and heart health educator.

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