Hormone Therapy and Heart Disease

“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”.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?

I think 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?

I think 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: Potential Risks the North American Menopause Society (NAMS) 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

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 explain:

“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. 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”.4

NICE Guidelines

What do the (British) National Institute for Health and Care Excellence’s (NICE) guidelines explain about hormone replacement therapy (HRT) and the risk of heart disease?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT the NICE explain about Heart Disease and Stroke (Cardiovascular Disease):

“Studies show that:

  • If you start HRT before you’re 60 it does not increase your risk of cardiovascular disease
  • HRT does not affect your risk of dying from cardiovascular disease
  • HRT tablets (but not patches or gels) slightly raise the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.

If you’re already at higher risk of cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your GP can give you more information”.5

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

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”.6

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”.7

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”.8

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”.9

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.10

What is VTE?

VTE can be an abbreviation for Venous Thromboembolism.

In Heart Disease: It’s Not Just for Men – You and Your Doctor: A Heart Healthy Partnership the (United States) National Heart, Lung, and Blood Institute (NHLBI) also remind us:

“A crucial step in determining your risk is to see your doctor for a thorough checkup. Your doctor can be an important partner in helping you set and reach goals for heart health. But don’t wait for your doctor to mention heart disease or its risk factors. Many doctors don’t routinely bring up the subject with women patients”.11

Health Topics A-Z

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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. Bioidentical Hormones Explained – A British Menopause Society Video
  4. Bioidentical Hormones: Are They Safer?
  5. Cardiovascular Diseases
  6. Change Your Numbers. Change Your Life.
  7. Combined Menopausal Hormone Therapy (MHT)
  8. Complementary Medicine Options for Menopausal Symptoms
  9. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  10. Consumer Health: Menopause, Hormone Replacement Therapy and Heart Health
  11. Coronary Heart Disease
  12. Coronary Heart Disease (CHD) Explained – A British Menopause Society Video
  13. Deciding About Hormone Therapy
  14. Deciding About Hormone Therapy Use
  15. Deep Vein Thrombosis
  16. Early Menopause Question Prompt ListDifferent Heart Diseases
  17. Early Menopause: Women’s Experiences – Resources and Information: Quick Links – 1. Question Prompt List
  18. Early Menopause: Women’s Experiences – Women’s Profiles
  19. Estrogen & Hormones
  20. Estrogen & Hormones: Estrogen and the Cardiovascular System
  21. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  22. Family History
  23. Goredforwomen.org [Go Red for Women, United States]
  24. HRT: Benefits and Risks – What You Should Know
  25. Healthy Body: Top 10 Healthy Heart Tips
  26. Heart Disease: It’s Not Just for Men
  27. Hormone Replacement Therapy
  28. Hormone Replacement Therapy (HRT)
  29. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  30. Hormone Replacement Therapy (HRT): Alternatives
  31. Hormone Replacement Therapy (HRT): Types
  32. Hormone Replacement Therapy Safe, Despite Rare Blood Clot Risks From Tablets
  33. Hormone Therapy In Postmenopausal Women: Primary Prevention of Chronic Conditions
  34. Hormone Therapy: Is It Right for You?
  35. Hormones and Your Heart
  36. Hot Flashes: Manage Without Medication?
  37. How Does Hormone Therapy Affect Heart Health In Transgender People?
  38. Infographic: Treat Your Heart As A House
  39. Information About Menopause [Multiply Languages] [Videos]
  40. Ischemic Heart Disease: What Should Women Know?
  41. Know Your Numbers? They Could Just Save Your Life
  42. Lifestyle and Behaviour Changes for Menopausal Symptoms
  43. Lifestyle and Behavioural Modifications for Menopausal Symptoms
  44. Listen To Your Heart: Learn About Heart Disease – What Are Your Risk Factors for Heart Disease?
  45. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  46. Mayo Clinic Minute: Lifestyle Changes To Manage Menopause Symptoms [+ Video Courtesy: Mayo Clinic News Network]
  47. Mayo Clinic Minute: What Is Heart Disease? [+ Video Courtesy Mayo Clinic News Network]
  48. Mayo Clinic Q&A Podcast: Don’t Miss A Beat With Preventive Heart Care [+ Video]
  49. Menopause
  50. Menopause
  51. Menopause Explained – A British Menopause Society Video
  52. Menopause Hormone Therapy and Your Heart
  53. Menopause Hormone Therapy and Your Heart: How To Limit the Risks
  54. Menopause Hormone Therapy: Follow-Up Appointments?
  55. Menopause Hormone Therapy: Who Shouldn’t Take It?
  56. Menopause Management: Hormone Replacement Therapy (HRT) – Cardiovascular Disease
  57. Menopause Treatment
  58. Menopause and Heart Disease
  59. Menopause and Heart Disease
  60. Menopause and Heart Disease: Does HRT Affect Your Risk of Heart and Circulatory Disease?
  61. Menopause and Your Health
  62. Menopause – Is Menopausal Hormone Therapy (HRT) Safe? [Multiply Languages] [Video]
  63. Menopause – Non-Hormonal Treatment Options [Multiply Languages] [Video]
  64. Menopause – What Is Menopausal Hormone Therapy (HRT)? [Multiply Languages] [Video]
  65. Menopause: Diagnosis & Treatment
  66. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  67. Menopause: Hormone Replacement Therapy (HRT) [Video Interview Stories]
  68. Menopause: Medicines To Help You
  69. Menopause: Menopause – Hormone Treatments
  70. Menopause: Non-HRT and Lifestyle Options [Video Interview Stories]
  71. Menopause: Non-Hormonal Treatment & Relief for Hot Flashes
  72. National Center for Complementary and Integrative Health: Cardiovascular Disease
  73. National Center for Complementary and Integrative Health: Chelation for Coronary Heart Disease: What You Need To Know
  74. National Center for Complementary and Integrative Health: Herbs At A Glance
  75. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  76. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  77. National Center for Complementary and Integrative Health: Menopausal Symptoms In Depth
  78. Non-Hormonal Treatment Options for Menopausal Symptoms
  79. Oestrogen Only Menopausal Hormone Therapy
  80. Protect Your Heart
  81. Report on Latest Menopause Science Looks At Heart Risks
  82. Revised Global Consensus Statement on Menopausal Hormone Therapy
  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. Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
  88. Video Series-2018 – Tailoring Estrogen Therapy for Maximum Cardiovascular Health
  89. Video Series-2020 – TSECs—A New Treatment for Hot Flashes and Night Sweats
  90. Video Series-2020 – What Women Need To Know About Heart Disease
  91. Video Series-2020 – What You Need To Know About Bioidentical Hormone Therapy
  92. Video Series-2021 – What Women Need To Know About Hormone Therapies
  93. What Is Cardiovascular Disease?
  94. What Is Menopausal Hormone Therapy (MHT) and Is It Safe?
  95. What It Means To Go Red for Women [+ Video]
  96. Women and CVD – Facts and Tips: How To Protect Your Heart – Protect Your Heart
  97. Women and CVD – Facts and Tips: Know Your Numbers
  98. Women’s Wellness: Mindfulness May Ease Menopausal Symptoms
  99. Women’s Wellness: Treating Hot Flashes and Night Sweats Without Hormones [+ Video Courtesy: Mayo Clinic News Network]
  100. World Heart Day 29 September World Heart Day 2020

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. 17 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 14 May 2021
  2. Cardiovascular Diseases. World Health Organization https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed: 14 May 2021
  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: 14 May 2021
  4. 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: 14 May 2021
  5. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT – Heart Disease and Stroke (Cardiovascular Disease). Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 14 May 2021
  6. 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: 14 May 2021
  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;19:4:313-314 https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 14 May 2021
  8. Menopause Hormone Therapy and Your Heart: Who Should Not Take Hormone Therapy. 17 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 14 May 2021
  9. Menopause Hormone Therapy and Your Heart: Risks In Perspective. 17 October 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 14 May 2021
  10. 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 B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/wp-content/uploads/2020/08/global-consensus-hrt-2016-06.pdf Accessed: 14 May 2021
  11. Heart Disease: It’s Not Just for Men – You and Your Doctor: A Heart Healthy Partnership. National Heart, Lung, and Blood Institute https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth/heart-disease-not-just-men Accessed: 14 May 2021

Topic Last Updated: 14 May 2021 – Topic Last Reviewed: 14 May 2021
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