When hormone replacement therapy (HRT) for menopausal women was first developed, doctors and patients alike hoped it would finally free women from both the bothersome side effects and the serious health risks of menopause, like the increased chance of developing heart disease. While early studies led many doctors to prescribe (HRT) for menopausal women to prevent the disease, some doctors also prescribed it in the hopes that it would decrease the chances of a heart attack or stroke for women who were already diagnosed. Based on the research available now, this is no longer a recommended course of treatment.
The Original Assumptions
Estrogen does play an important role in keeping the heart healthy, so it's not surprising why it was assumed that the lack of it in menopausal women was part of why aging women experienced rising risks for developing heart disease. The original trend to prescribe HRT as a preventative for heart disease in menopausal women was based on observational studies that are now criticized for using flawed methodologies.
Since those early observational studies seemed to show a reduction in stroke and heart attack risks for women without a heart disease diagnosis, it was also assumed that HRT could lower the risks of those two serious problems in women with a diagnosis too. Unfortunately, neither of those assumptions turned out to be true once more thorough and better controlled studies were completed.
The 20-year-long Heart and Estrogen/Progestin Replacement Study was the first controlled study to examine these assumptions, and it was split into two parts. One section focused specifically on women who already had signs of underlying heart disease, such as at least prior heart attack or damage to the heart that was visible on an angiograph. In these women specifically, there was no significant reduction in the number of heart attacks or strokes experienced. While other parts of the study found preventative benefits for women with healthier cardiovascular systems, the women who already had heart disease did not benefit from HRT.
Rising Risk Factors
In fact, follow up studies even found that taking certain types of HRT with heart disease actually made a heart attack or other life threatening event more likely instead of less. While estrogen alone failed to produce any protective effects, combined estrogen and progestin treatments are linked to increased risks. It's serious enough that organizations like the National Heart, Lung, and Blood Institute officially discourage doctors from prescribing HRT to any woman with diagnosed heart disease or a potential case. Until heart disease is ruled out through a series of tests, women should wait to begin any type of estrogen or progestin treatment to manage their menopause symptoms.
If your most serious menopause side effects are hot flashes and mood swings, it's best to rely on non-hormonal treatments to avoid the risk of worsening your existing heart disease. However, HRT may be the only option for women with aggressive osteoporosis that is not responding to other treatments or who cannot take the alternative treatments for bone density loss. In these cases, the cardiovascular risks can be minimized by
- Using the hormones for as short of a time period as possible, since long term use is the most strongly associated with heart attacks and strokes
- Using estrogen alone, if your doctor says it will be effective enough to stop bone density loss
- Using other treatments at the same time for managing your cardiovascular disease, such as medications to control your blood pressure and cholesterol levels.
Heart Disease Treatments
If HRT is off the table, what should menopausal women do for heart disease treatment? Well-tested and less risky treatment options include
- Lifestyle changes like weight loss, balanced diets, and increased amounts of doctor-recommended exercise
- Medications designed to manage exacerbating factors, like blood pressure levels, and reduce the workload on the heart
- Surgeries to repair damaged or clogged arteries.