“For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for…”.1

Umbrella
What may the Hormone Therapy and Heart Disease, Stroke Prevention Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Cardiovascular Disease
  • Coronary Heart Disease
  • Heart Disease
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Ischemic Heart Disease
  • Menopausal Hormone Therapy (MHT)
  • Stroke

Cardiovascular Diseases

What are cardiovascular diseases (CVDs)?

DotS the definition of CVDs may vary. The World Health Organization’s definition is:

“CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions”.2

Type

Hormone Therapy and Heart Disease, Stroke PreventionHormone Therapy and Heart Disease, Stroke PreventionWhat can it be important to be clear about with hormone therapy (HT) and heart disease and stroke prevention information?

I think it can be important to be clear about the type of HT and heart disease and stroke prevention information is about – Estrogen Plus Progestogen HT or Estrogen-Alone HT.

Younger Than Age 60 or Not

What can it also be important to be clear about with HT and heart disease and stroke prevention information?

I think it can also be important to be clear about whether HT and heart disease and stroke prevention information is about women “younger than age 60 years or within 10 years of menopause” or not.

Younger Than Age 60

For women younger than age 60 or within 10 years of menopause, what is the association between HT and heart disease and stroke prevention?

On page one in Deciding About Hormone Therapy: Potential Risks the North American Menopause Society in June 2017 explain:

“Some studies suggest that HT might be good for your heart if you start before age 60 or within 10 years of menopause”.3

For women younger than 60 or within 10 years of menopause, what are some points of consensus about MHT and cardioprotection?

Some points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, are:

  • “RCTs and observational data as well as meta-analyses provide evidence that standard-dose estrogen-alone MHT may decrease the risk of myocardial infarction and all cause mortality when initiated in women younger than 60 years of age and/or within 10 years of menopause
  • Data on estrogen plus progestogen MHT initiated in women younger than age 60 years or within 10 years of menopause show a less compelling trend for mortality benefit, and evidence on cardioprotection is less robust with inconsistent results compared to the estrogen-alone group”.4

What is RCTs?

RCTs can be an abbreviation for Randomized Controlled Trials.

After Age 60

For women after age 60 or further than 10 years from menopause, what is the association between HT and heart disease and stroke prevention?

On page one in Deciding About Hormone Therapy: Potential Risks the North American Menopause Society in June 2017 elaborate on:

“… if you start HT further from menopause or after age 60 , HT might slightly increase your risk of heart disease. Although there are risks associated with taking HT, they are not common, and most go away after you stop treatment. In general, HT is associated with fewer than 2 additional harmful events per 1,000 women per year. For example, the increased chance of breast cancer with HT use is 1 extra case per 1,000 women per year”.5

On page one in NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use: Hormone Therapy Remains the Most Effective Treatment for Hot Flashes and Other Troublesome Menopause Symptoms, Regardless of a Woman’s Age published on 20 June 2017, the North American Menopause Society (NAMS) also note:

  • “For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia”.6

U.S. Preventative Services Task Force

In 2017, what did the (United States) U.S. Preventative Services Task Force note in their final recommendations for women who have gone through menopause and the primary prevention of chronic conditions such as heart disease, stroke, diabetes, dementia, cancer and bone fractures?

In Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions the USPSTF’s recommendations include:

Hormone Therapy and Heart Disease, Stroke Prevention

“Postmenopausal women
The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women”.7

In Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions the USPSTF’s recommendations also include:

Hormone Therapy and Heart Disease, Stroke Prevention

“Postmenopausal women who have had a hysterectomy
The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women who have had a hysterectomy”.8

Health Care Provider

What if I choose to use HT and would like to lower my risk of heart disease and/or stroke?

If you would like to choose to use HT and lower your risk of heart disease and/or stroke, it may be in your best interest to also choose to talk to your health care provider about this. Together you can discuss your options and if required, agree on who may be the most appropriate health care provider to help you.

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy, Heart Disease and Stroke Prevention?

In Health Topics A-Z you may find:

Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use: Hormone Therapy Remains the Most Effective Treatment for Hot Flashes and Other Troublesome Menopause Symptoms, Regardless of a Woman’s Age. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 04 June 2020
  2. Cardiovascular Diseases. World Health Organization https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed: 04 June 2020
  3. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 04 June 2020
  4. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313-314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 04 June 2020
  5. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 04 June 2020
  6. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use: Hormone Therapy Remains the Most Effective Treatment for Hot Flashes and Other Troublesome Menopause Symptoms, Regardless of a Woman’s Age. 20 June 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/default-document-library/ht-press-release-061917.pdf Accessed: 04 June 2020
  7. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions. Release Date: December 2017. Current As of: December 2017. U.S. Preventative Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/menopausal-hormone-therapy-preventive-medication Accessed: 04 June 2020
  8. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions. Release Date: December 2017. Current As of: December 2017. U.S. Preventative Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/menopausal-hormone-therapy-preventive-medication Accessed: 04 June 2020
Topic Last Updated: 04 June 2020 – Topic Last Reviewed: 04 June 2020
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