“If you’re having a tough time with symptoms of menopause but worry about how hormone therapy will affect your heart, talk with your doctor to…”.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 already 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’re having a tough time with symptoms of menopause but worry about how hormone therapy will affect your heart, 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

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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. 01 August 2018. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 05 August 2020
  2. Cardiovascular Diseases. World Health Organization https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 Accessed: 05 August 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: 05 August 2020
  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: 05 August 2020
  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: 05 August 2020
  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/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 05 August 2020
  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/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 05 August 2020
  8. Menopause Hormone Therapy and Your Heart: Who Should Not Take Hormone Therapy. 01 August 2018. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 05 August 2020
  9. Menopause Hormone Therapy and Your Heart: Risks In Perspective. 01 August 2018. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 05 August 2020
  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/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 05 August 2020
  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: 05 August 2020

Topic Last Updated: 23 August 2020 – Topic Last Reviewed: 05 August 2020
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