“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

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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. 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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