Hormone Therapy and Heart Disease

“If you already have heart disease or you have a history of
blood clots, the risks of hormone therapy have been
clearly shown to outweigh any potential benefits”.1

Umbrella
What may the Hormone Therapy and Heart Disease 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)

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 DiseaseHormone Therapy and heart Disease What can it be important to be clear about with hormone therapy (HT) and heart disease risk information?

It can be important to be clear about the type of HT and whether heart disease risk 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 risk information?

It can also be important to be clear about whether HT and heart disease risk 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 risk?

On page one in Deciding About Hormone Therapy Use: Potential Risks published July 2022, the North American Menopause Society (NAMS) 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

On page two in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause first published 10 June 2022, one of the recommendations is:

  • “Evidence from Cochrane database analysis suggests that HRT started before the age of 60 or within 10 years of the menopause may result in reduction in atherosclerosis progression, coronary heart disease and may lower cardiovascular and all-cause mortality”.4

After Age 60

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

On page one in Deciding About Hormone Therapy Use: Potential Risks the NAMS also note:

“However, 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”.5

On page 780 in The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Cardiovascular Disease and All-Cause Mortality – Key Points published July 2022 and “endorsed by more than 20 well-respected international organizations”, one of the key points is:

“Women who initiate hormone therapy aged older than 60 years or more than 10 or 20 years frommenopause onset are at higher absolute risks of CHD, VTE, and stroke than women initiating hormone therapy in early menopause. (Level I)”.6

What is Level I?

In this context “Level I: Based on good and consistent scientific evidence”.

Estrogen Plus Progestogen

Hormone Therapy and Heart DiseaseIs there an association between estrogen plus progestogen MHT (Menopausal Hormone Therapy) and cardioprotection?

One of the 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, is:

  • “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”.7

Estrogen-AloneHormone Therapy and Heart Disease

Is there an association between estrogen-alone MHT and myocardial infarction?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefits/Risk Profile of MHT is:

  • “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”.8

What is RCTs?

RCTs can be an abbreviation for Randomized Controlled Trials.

What is myocardial infarction?

DotS myocardial infarction can be another term for heart attack.

History Risk

With a history of heart attack, heart disease or blood clots, can the risks of HT outweigh the benefits?

In Menopause Hormone Therapy and Your Heart: Who Should Not Take Hormone Therapy the (United States) Mayo Clinic note:

“If you’ve had a heart attack, menopause hormone therapy is not for you. If you already have heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits”.9

Health Care Provider

If I choose to use HT what are my risks of heart disease?

Different women who choose to use HT can have different risks of heart disease. It may therefore be in your best interest to also choose to talk to your health care provider about this. The Mayo Clinic explain:

“If you are struggling with menopause symptoms but worry about the potential risks of hormone therapy, talk with your doctor to put your personal risk into perspective”.10

Health Topics A-Z

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

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. A Systematic Review and Meta-Analysis of Effects of Menopausal Hormone Therapy on Cardiovascular Diseases
  3. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  4. Bioidentical Hormones Explained – A British Menopause Society Video
  5. Bioidentical Hormones: Are They Safer?
  6. Cardiovascular Diseases
  7. Change Your Numbers. Change Your Life.
  8. Combined Menopausal Hormone Therapy (MHT)
  9. Complementary Medicine Options for Menopausal Symptoms
  10. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  11. Consumer Health: Menopause, Hormone Replacement Therapy and Heart Health
  12. Coronary Heart Disease
  13. Coronary Heart Disease (CHD) Explained – A British Menopause Society Video
  14. Deciding About Hormone Therapy
  15. Deciding About Hormone Therapy Use
  16. Deep Vein Thrombosis
  17. Different Heart Diseases
  18. Early Menopause: Women’s Experiences – Resources and Information: Quick Links – 1. Question Prompt List
  19. Early Menopause: Women’s Experiences – Women’s Profiles
  20. Estrogen & Hormones
  21. Estrogen & Hormones: Estrogen and the Cardiovascular System
  22. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  23. Family History
  24. Find A Menopause Practitioner [United States and Other]
  25. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  26. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  27. Goredforwomen.org [Go Red for Women, United States]
  28. HRT: Benefits and Risks – What You Should Know
  29. HRT: Types, Doses and Regimens
  30. Heart Disease: It’s Not Just for Men
  31. Hormone Replacement Therapy
  32. Hormone Replacement Therapy (HRT)
  33. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  34. Hormone Replacement Therapy (HRT): Alternatives
  35. Hormone Replacement Therapy (HRT): Types
  36. Hormone Replacement Therapy Safe, Despite Rare Blood Clot Risks From Tablets
  37. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions
  38. Hormone Therapy: Is It Right for You?
  39. Hot Flashes: Manage Without Medication?
  40. How Does Hormone Therapy Affect Heart Health In Transgender People?
  41. Infographic: Treat Your Heart As A House
  42. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  43. Know Your Numbers They Could Just Save Your Life
  44. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  45. Lifestyle and Behaviour Changes for Menopausal Symptoms
  46. Lifestyle and Behavioural Modifications for Menopausal Symptoms
  47. Listen To Your Heart: Women and Heart Disease
  48. MHT Still Maligned & Misunderstood: Expert
  49. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  50. Managing Menopausal Symptoms—Hormone Replacement Therapy Is Not the Only Option!
  51. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  52. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  53. Mayo Clinic Minute: What Is Heart Disease? [+ Video Courtesy Mayo Clinic News Network]
  54. Mayo Clinic Q&A Podcast: Don’t Miss A Beat With Preventive Heart Care [+ Video]
  55. Menopausal Hormone Therapy
  56. Menopausal Hormone Therapy and Venous Thromboembolism
  57. Menopausal Hormone Therapy, Heart Disease and Stroke
  58. Menopause
  59. Menopause
  60. Menopause Explained – A British Menopause Society Video
  61. Menopause Hormone Therapy and Your Heart
  62. Menopause Hormone Therapy and Your Heart: How To Limit the Risks
  63. Menopause and Heart Disease
  64. Menopause and Heart Disease
  65. Menopause and Heart Disease: Does HRT Affect Your Risk of Heart and Circulatory Disease?
  66. Menopause and Your Heart
  67. Menopause: Diagnosis & Treatment
  68. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  69. Menopause: Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  70. Menopause: Medicines To Help You
  71. Menopause: Menopause – Hormone Treatments
  72. Menopause: What Is Menopausal Hormone Therapy (HRT)? [Multiply Languages] [Video]
  73. National Center for Complementary and Integrative Health: Cardiovascular Disease
  74. National Center for Complementary and Integrative Health: Chelation for Coronary Heart Disease: What You Need To Know
  75. National Center for Complementary and Integrative Health: Herbs At A Glance
  76. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  77. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  78. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  79. Natural Remedies To Help Manage Perimenopause Symptoms
  80. Oestrogen Only Menopausal Hormone Therapy
  81. Protect Your Heart
  82. Report on Latest Menopause Science Looks At Heart Risks
  83. Risk Factors: Cardiovascular Risk Factors
  84. Top Health Checks for Women
  85. Tuesday Tips: 8 Ways To Reduce Your Risk of Heart Disease [+ Video]
  86. Types of Hormone Therapy
  87. Using Natural Therapies In the Menopause Transition – Webinar
  88. Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
  89. Video Series-2018: Tailoring Estrogen Therapy for Maximum Cardiovascular Health
  90. Video Series-2020: What You Need To Know About Bioidentical Hormone Therapy
  91. Video Series-2021 – How Clinicians Determine Which Women May Benefit From Statin Therapy
  92. Video Series-2021: What Women Need To Know About Hormone Therapies
  93. Video Series-2021: What You Need to Know About the #1 Cause of Death in Women
  94. Webinars: Previous – Primary Prevention of Cardiovascular Disease With MHT – Where Are We Now?
  95. Webinars: Previous – The Early Menopausal Patient
  96. What Is Cardiovascular Disease?
  97. Women’s Wellness: Mindfulness May Ease Menopausal Symptoms

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Menopause Hormone Therapy and Your Heart: Risks In Perspective. 20 May 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 07 September 2022
  2. Cardiovascular Diseases. World Health Organization https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed: 07 September 2022
  3. Deciding About Hormone Therapy Use: Potential Risks. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 07 September 2022
  4. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayesena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 07 September 2022
  5. Deciding About Hormone Therapy Use: Potential Risks. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 07 September 2022
  6. The 2022 Hormone Therapy Position Statement of The North American Menopause Society: Cardiovascular Disease and All Cause Mortality – Key Points. 2022: 780 North American Menopause Society https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf Accessed: 07 September 2022
  7. 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 https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 07 September 2022
  8. 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: 07 September 2022
  9. Menopause Hormone Therapy and Your Heart: Who Should Not Take Hormone Therapy. 20 May 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 07 September 2022
  10. Menopause Hormone Therapy and Your Heart: Risks In Perspective. 20 May 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 07 September 2022
Topic Last Updated: 07 September 2022 – Topic Last Reviewed: 04 March 2022

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