Hormone Replacement Therapy And Heart Disease In Women

For a number of years, inconsistent reports about women, HRT, and heart disease have been circulating, concerning risks and benefits of hormone replacement therapy (HRT). A new study has concluded that HRT can reduce heart attacks by about one-third in women under age 60, yet in older women the results are mixed.

What is HRT?

Hormone Replacement Therapy, or HRT, is simply the replacement of hormones that a woman loses around the time of menopause. The hormone replaced is Estrogen. Estrogen is needed for the female reproductive system, and is mainly manufactured by the ovaries. It is also made by other organs such as the liver and the adrenal glands. A more potent form of Estrogen, called Estriodol, is found in premenopausal women. During menopause, estrogen production stops, leading the other tissues to produce it instead. Post menopausal women produce a weaker form called estrone made by the adrenal glands.

There are two types of HRT available to women:

Bioidentical Hormones: Are the same as those found naturally in the human female body, and they can be custom-compounded to your specific needs and titrated over time.

Synthetic: Is made from the urine of pregnant mares (female horse).

HRT is prescribed for two groups of women:

Women going through menopause and women who are post-menopausal. The natural levels of these hormones drop during menopause, which can lead to symptoms such as hot flashes, night sweats, vaginal dryness, and sleep disturbances. HRT may be used to help lessen some of these symptoms.

For women with certain health conditions, such as premature ovarian failure, HRT replaces the hormones that their bodies are not making.

Potential side effects HRT:

Risks observed with HRT use varies by a woman’s age; her environmental, nutritional, and lifestyle factors; and her genetics and medical history. The type, combination, and dosage of hormones used; the route of delivery; and duration of treatment also have a great bearing on the risks.

• Endometrial bleeding


• Breast tenderness


• Increased breast density, higher rates of abnormal mammograms and breast biopsies


• Breast cancer


• Cardiovascular events (e.g., heart attack, stroke, cardiovascular death)


• Gallbladder disease


• Venous thromboembolic events (blood clots)


• Reduced insulin sensitivity


• Brain atrophy, increased risk of dementia, decline in memory and cognition

The Analysis:

Analysis of more than 39,000 women found that women who started HRT (estrogen with or without progesterone) in their 50s to relieve hot flashes, their heart attack risk or cardiac death fell by 32 percent, compared with those receiving a placebo or no treatment. Women over the age of 60 taking HRT, their risk of heart attacks increased first year of treatment, but after two years their heart attack risks decreased, compared with women taking a placebo or no treatment.

Fewer Deaths for women over 60:

The study also found 39 percent fewer deaths among women who began HRT before 60, compared with women of the same age given a placebo or no treatment.

Risks And Benefits:

Diverse reports relating to risks and benefits of HRT have been all the more perplexing for women, due to a report stating HRT was linked to more heart attacks in women age of 63 years of age, as compared to younger women who started HRT at an earlier age. Younger women may respond differently to HRT than older women. Since then, researchers have provided data for coronary heart disease events for younger and older women separately. Trials for younger women found a 32 percent reduction in coronary heart disease for women who start treatment in their 50s.

A study found that HRT drastically reduces diabetic risks compared with placebo but increases the levels of a protein associated with inflammation in the body. This may reduce heart attacks in younger women with no history of heart disease, but increases the risks for older women who already have cardiovascular disease.

The latest study reports that HRT reduces coronary heart disease in women starting treatment shortly after menopause. Conversely, other studies suggest an increase in the risk of breast cancer, but decreased risk of colorectal cancer. Thus, HRT treatment is a personal choice, and consulting with your doctor about any fears and misgivings will help women make the correct choices for HRT in their lives.

by Barb Hicks RN/LMT