Hormones Are No Heart Shield for Women

Hormone replacement therapy might not prevent coronary heart disease

(RxWiki News) Women thinking about therapy to normalize their hormone levels have lots to keep in mind. For one, hormone therapy might not protect the heart.

Menopausal hormone therapy should not be used to prevent coronary heart disease, according to new recommendations by the American College of Obstetricians and Gynecologists (ACOG).

These therapies include hormone replacement therapy (HRT) and estrogen therapy (ET).

Though studies have shown that estrogen therapy can significantly reduce the amount of calcium in the arteries, the researchers said that there is not enough evidence to conclude that long-term ET or HRT improves cardiovascular outcomes.

The ACOG suggested that women's quality of life issues be considered when prescribing the therapies and each woman's personal needs should be taken into account.

"Ask your OB/GYN about the risks of hormone replacement therapy."

The new recommendations, based on new clinical and scientific data by researchers at ACOG, replace previous opinions on hormone therapy usage and how it affects coronary heart disease risk.

In coronary heart disease, plaque builds up inside the arteries that serve the heart. The buildup from fat and cholesterol can lead to atherosclerosis, or hardening of the arteries.

Too much buildup can lead to the formation of blood clots. The arteries could then break open, which causes the flow of oxygen to the heart to decrease.

The researchers looked at a number of previously published studies on menopausal hormone therapies, which ease hot flashes and vaginal dryness in women who do not generate enough estrogen on their own, and how the therapy is linked to heart health.

One of the included studies was conducted by the Women's Health Initiative (WHI), and another involved the Heart and Estrogen/progestin Replacement Study (HERS).

The WHI addresses the most common causes of disability, impaired quality of life and death in postmenopausal women. HERS tested the safety and effectiveness of estrogen with progestin therapy in preventing coronary heart disease.

Some of the studies supported that women's heart health might benefit if they begin using estrogen or hormone therapy near the start of menopause, but the ACOG stated the ties between the two studies need to be investigated further.

According to the ACOG, evidence that supports long-term estrogen therapy or hormone therapy in improving cardiovascular health is insufficient.

In addition, the findings of the WHI study might not be applicable to younger women who have just begun menopause. The average age of that study's participants was 63 years of age.

The current report also stated that use of the hormone replacement and estrogen therapies should be individualized and based on each woman's symptoms and ratio of risks to benefits, as some women might need longer treatment time.

"Clinicians should encourage heart-healthy lifestyles and other strategies to reduce cardiovascular risk in menopausal women," the report stated. "Quality of life issues also may be considered when prescribing ET and [hormone therapy]."

Researchers are still trying to tease out who might benefit and who might be harmed by HRT, said Sarah Samaan, MD, FACC, a board certified cardiologist and dailyRx Contributing Expert who is not affiliated with the ACOG.

"The bottom line is that there is simply not enough medical research to clarify who to treat, what form of HRT to use, and for how long," Dr. Samaan said. "While we do not currently prescribe HRT to protect heart health, it may turn out that it may be protective for some women, yet harmful to others."

Additional studies should also look at the difference between progesterone and synthetic progesterone usage, according to the report.

This report was published in the June issue of Obstetrics & Gynecology.

Review Date: 
June 5, 2013