Hormone Therapy and Heart Disease, Stroke Prevention

“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

TypeHormone Therapy and Heart Disease, Stroke PreventionHormone Therapy and Heart Disease, Stroke Prevention

What can it be important to be clear about with hormone therapy (HT) and heart disease and stroke prevention information?

It can be important to be clear about the type of HT – Estrogen Plus Progestogen HT or Estrogen Therapy.

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?

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”.

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:


“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:

“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:

Health Topics A-Z

Links

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Links

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  1. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT): 4. Misunderstanding – MHT Increases the Risk of Heart Disease
  2. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  3. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  4. Bioidentical Hormone Therapy
  5. Bioidentical Hormones Explained – A British Menopause Society Video
  6. Bioidentical Hormones: Are They Safer?
  7. COVID-19 & CVD
  8. Cardiovascular Diseases
  9. Combined Menopausal Hormone Therapy (MHT)
  10. Complementary Medicine Options for Menopausal Symptoms
  11. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  12. Coronary Heart Disease (CHD) Explained – A British Menopause Society Video
  13. DVT (Deep Vein Thrombosis)
  14. Deciding About Hormone Therapy
  15. Deciding About Hormone Therapy Use
  16. EMAS Menopause Essentials
  17. EMAS Replay: The Relevance of Estrogen and Progestogen Choice for Breast Safety During MHT [Multiply Languages]
  18. EMAS Replay: Risk Assessment for MHT – When, To Whom, Which, and How Long? [Multiply Languages]
  19. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Resources and Information: Quick Links – 1. Question Prompt List
  20. Early Menopause: Experiences and Perspectives of Women and Health Practitioners – Women’s Profiles
  21. Estrogen & Hormones: Estrogen & Heart Disease
  22. Estrogen & Hormones: Estrogen & Heart Disease – Post-Menopausal Hormone Replacement Therapy
  23. Estrogen, Hormone Therapy and Menopause
  24. Family History
  25. Find A Menopause Practitioner [United States and Other]
  26. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  27. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  28. Goredforwomen.org [Go Red for Women]
  29. HRT: Benefits and Risks
  30. HRT: Summary
  31. HRT: Types, Doses and Regimens
  32. Hormone Replacement Therapy
  33. Hormone Replacement Therapy (HRT)
  34. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  35. Hormone Replacement Therapy (HRT): Alternatives
  36. Hormone Replacement Therapy (HRT): Types
  37. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions
  38. Hormone Therapy for Menopause
  39. Hormone Therapy: Is It Right for You?
  40. Hot Flashes: Manage Without Medication?
  41. Hot Flashes: What Can I Do?
  42. How To Prevent Heart Disease After Menopause
  43. Infographic: Women and Heart Disease
  44. Information About Menopause [Multiply Languages] [Videos]
  45. Know Your Numbers? They Could Just Save Your Life
  46. Later Years (Around 50 Years and Over): Menopause and Postmenopause Health – The Menopause: Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  47. Later Years (Around 50 Years and Over): Menopause and Postmenopause Health – Menopause [+ Video: Menopause Myths]
  48. Learning To Cope With Hot Flashes
  49. Lifestyle and Behaviour Changes for Menopausal Symptoms
  50. Lifestyle and Behavioural Modifications for Menopausal Symptoms
  51. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  52. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option!
  53. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video]
  54. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  55. Mayo Mindfulness: Tackle Stress, Anxiety and Depression To Benefit Your Heart
  56. Menopausal Hormone Therapy
  57. Menopausal Hormone Therapy, Heart Disease and Stroke
  58. Menopause
  59. Menopause
  60. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  61. Menopause Hormone Replacement Therapy and Your Heart
  62. Menopause Hormone Therapy: Follow-Up Appointments?
  63. Menopause Hormone Therapy: Who Shouldn’t Take It?
  64. Menopause Management: Hormone Replacement Therapy (HRT) – Cardiovascular Disease
  65. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Stages of Menopause: Postmenopause
  66. Menopause Symptoms and Relief
  67. Menopause Treatment
  68. Menopause and Heart Disease: Does Hormone Replacement Therapy (HRT) Affect Your Risk of Heart and Circulatory Disease?
  69. Menopause and Your Health
  70. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  71. Menopause: Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  72. Menopause: Medicines To Help You
  73. Menopause: Menopause – Hormone Treatments
  74. Menopause: What Is Menopausal Hormone Therapy (HRT)? [Multiply Languages] [Video]
  75. My Life Check | Life’s Simple 7
  76. NAMS 2017 Position Statement Updates Guidelines for Hormone Therapy Use
  77. National Center for Complementary and Integrative Health: Cardiovascular Disease
  78. National Center for Complementary and Integrative Health: Chelation for Coronary Heart Disease: What You Need To Know
  79. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  80. Non-Estrogen Treatments for Menopausal Symptoms
  81. NonHormonal Treatments for Menopausal Symptoms
  82. Oestrogen Only Menopausal Hormone Therapy
  83. Postmenopause
  84. Preventing Cardiovascular Disease
  85. Preventing Deep Vein Thrombosis
  86. Report on Latest Menopause Science Looks At Heart Risks
  87. Risks and Benefits of MHT
  88. The Heart Truth
  89. Tuesday Tips: 8 Myths About Heart Disease You Need To Know [+ Video]
  90. Video Series-2020: What You Need to Know About Bioidentical Hormone Therapy
  91. Video Series-2021: What You Need to Know About the #1 Cause of Death in Women
  92. Video Series-2021: What Women Need to Know About Hormone Therapies
  93. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  94. Videos and Podcasts: Interviews and Podcasts – Interviews: Menopause More Than Hot Flashes
  95. Videos and Podcasts: Interviews and Podcasts – Interviews: Prevention of Chronic Diseases In Women: Where Does MHT Fit In?
  96. Webinars: Previous – The Early Menopausal Patient
  97. Webinars: Previous – Primary Prevention of Cardiovascular Disease With MHT – Where Are We Now?
  98. What Can I Do To Help With Hot Flashes?
  99. What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  100. Women’s Wellness: Treating Hot Flashes and Night Sweats Without Hormones [+ Video]

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: 23 May 2022
  2. Cardiovascular Diseases. World Health Organization https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed: 23 May 2022
  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: 23 May 2022
  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/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 23 May 2022
  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: 23 May 2022
  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: 23 May 2022
  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: 23 May 2022
  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: 23 May 2022

Topic Last Updated: 23 May 2022 – Topic Last Reviewed: 23 May 2022
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