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Heart Smart Living
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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Menopause, Hormone Replacement, and Heart Health: Timing is Key

For years, the use of hormone replacement therapy for menopause has been a topic of great controversy. At the time of menopause, women’s estrogen levels naturally decline, triggering a host of unhappy symptoms, including hot flashes, insomnia, and thinning of the vaginal tissue. Some women breeze through this time of life without a second thought, while others may suffer for years. Although supplements and ant-depressants may be helpful for some women, estrogen therapy is far and away the most effective treatment.

Understanding Hormone Therapy

Estrogen replacement therapy (ERT) has been on the market since 1942. The first ERT, Premarin, distilled from the urine of pregnant horses, was once the best selling drug in the United States. Prescriptions declined drastically by 2002, when large studies of menopausal women suggested that the drug could cause more harm than good. Heart attacks, strokes, and blood clots were reported to be more common in women on ERT, when compared to women going through menopause without hormone therapy. Those at greatest risk were women taking Premarin along with progesterone. (If a woman has not had a hysterectomy, both are necessary in order to reduce the risk for uterine cancer).

In hindsight, it appeared that the highest risk women in the studies were those who were started on ERT five or more years after menopause had run its course. In reality, most women who opt for hormone therapy begin it at the time of menopause. This discrepancy led many to question the results of the studies. Nevertheless, some younger women also suffered serious side effects.

ERT Study Findings

In the September 18, 2011 edition of the medical journal Menopause, researchers from Cedars-Sinai Medical Center in Los Angeles reported on their study of 654 postmenopausal women. These women had all been sent for a heart catheterization, which is a study of the heart arteries in which a small tube is inserted into the heart through which dye is injected, in order to find out whether there is a blockage. The results were tallied, and the women were followed up for several years after.

Overall, women who had taken ERT were less than half as likely to have blockages as women who had never taken hormones. Those who appeared to have the most benefit were those who started the drug before the age of 55.

Alternatives to ERT

The issue is far from settled. Although the majority of research on ERT has focused on Premarin, several other prescription forms of ERT are available. Some of these may be safer alternatives, particularly the estrogen patches. Women who already have cholesterol buildup appear to be at higher risk for complications of ERT than women with healthy arteries.  

I tell my patients that ERT is a moving target. New research is cropping up all the time, and although it may seem contradictory, each new study advances our understanding of who ERT might benefit, and who it might harm. If you are going through menopause, this is an important discussion to have with your doctor, understanding that there is no “one size fits all” answer to the menopause puzzle.

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Tags: Women and Heart Health

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About the Author


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