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Cardiovascular disease, postmenopause, and HRT

When it comes to taking hormone replacement therapy (HRT) and the associated health risks, timing is everything. Cardiovascular disease affects greater numbers of women, and those risks increase during postmenopause. Does HRT contribute to heart disease or increase the chances of having a heart attack?

The age a woman begins taking HRT and for how long she undergoes treatment are two very important factors to consider.

With all the controversy surrounding HRT, it can be confusing for women trying to decide on a course of menopause treatment. Will the health risks outweigh the benefits? Am I at greater risk of developing some type of health issue while taking HRT? Is HRT safe? Should I deal with today’s menopause symptoms like hot flashes when the trade-off could be greater health problems in the years to come?

Throughout the last decade, the arguments both for and against taking HRT have caused women a great deal of fear and anxiety. Some of this is founded in science, some of it in myth. HRT, as with any medication, does come with some possible side effects. But the likelihood of those effects varies from woman to woman. More importantly, the effects depend on the level of dosage prescribed and the length of time a woman takes HRT.

Recent presentations at the 22nd North American Menopause Society’s Annual Meeting indicate the progress in separating the facts from the fables. For the last few years, several prominent celebrities and physicians have denounced HRT outright claiming that women are putting themselves at greater health risks while trying to relieve temporary menopause symptoms. This is a very important point to think about; some women will not tolerate HRT very well or may not need to reach for the prescriptions.

Both traditional and alternative medical supporters agree that lifestyle management leads to better health both during and beyond menopause. Women can significantly reduce their risks of cardiovascular disease, heart attack, and stroke through adopting a healthy diet, daily exercise, and stress reduction.

At the same time, better health means better menopause symptom management. But what happens for those women for whom menopause presents severe symptoms that require some type of medical attention? Where does HRT fit into the picture?
Observational and Random Controlled Studies show growing proof that the earlier a woman begins taking HRT, at the lowest possible dose to deal with menopause symptoms, the lower the risk for developing cardiovascular disease.

As Dr. Howard Hodis et al presented in their findings, HT reduces both total mortality and coronary heart disease when initiated in younger postmenopausal women under 60 years old who started taking HRT very early on in menopause or at the time of confirmed postmenopause (the end of menstrual periods).

These studies also show the long-term benefits for taking HRT. Women who started taking HRT in their early 50s have greater longevity and a better quality of life (better heart health) during those years. As Dr. Hodis states based on his work and that of his peers “A ‘window of opportunity’ (exists) for the reduction of coronary heart disease and total mortality with menopausal therapies is age- and time- dependent.”

For women thinking about whether HRT is right for them, the key is to start talking to healthcare providers about HRT and the alternatives. Also crucial is an individual woman’s overall health history and in particular her heart health and susceptibility of developing coronary heart disease.

The important point is that HRT is a viable option for some women while other women may not need to undergo traditional treatments. But making the right choice means making an informed decision, getting the facts and making those decisions based on research and healthy skepticism versus fear and media hype.

Hodis, Howard MD, University of Southern California “Postmenopausal hormone therapy and cardiovascular risk in women” as presented at the 22nd Annual General Meeting of the North American Menopause Society, Washington D.C. 2011.

Menopause, Your Doctor, and You

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