Hormone Replacement Therapy & the Risk of a Heart Attack

For years, women routinely used hormone-replacement therapy (HRT) to cope with the side effects of menopause, such as hot flashes and mood swings. The hormones were used to replace those that the body had quit producing and were thought to also protect women from heart disease. However, in 2002, a study called the Women's Health Initiative (WHI) found that HRT may actually increase the risk of heart attack and cause other serious health conditions.

WHI

• The Women's Health Initiative studied the effect of hormone replacement on menopausal women. Two kinds of hormone therapy were reviewed: estrogen plus progestin and estrogen alone. The research was implemented because previous studies had conflicting results about whether there was a link between hormone therapy and increased health risks. Previous data suggested that taking hormones protected a woman from heart disease after menopause.

Heart Attack

• Released in May 2002, WHI findings showed that women taking estrogen plus progestin had a higher risk of heart attacks. In addition, this group also had a higher rate of strokes and blood clots. As a result, women in the study were told to discontinue taking hormone- replacement pills.

  Women who only took estrogen alone in the study did not report a higher rate of heart attack, though they did have more strokes and blood clots.

  Three years later, because of the WHI and other HRT studies' findings, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against the routine use of combined estrogen and progestin to relieve conditions caused by menopause.

HRT Alternatives

• The National Institutes of Health, together with other health organizations, recommend other methods besides HRT to cope with the symptoms of menopause. The majority are lifestyle changes that make menopause more comfortable. These include avoiding spicy foods and caffeine that may raise the body temperature and sleeping in a cool room.

  Maintaining a healthy weight and being physically active can also help. Soybeans and some soy-based foods have substances that may relieve hot flashes. Antidepressants are effective at managing some of the emotional issues associated with menopause.

New Study

• A study published in May 2009 in the Journal of the Medical Care Section of the American Public Health Association reported that the reduction in hormone therapy by U.S. women mirrored a reduction in female heart attacks. However, the number of women who had strokes remained stable. It appears that women who don't use HRT have fewer heart attacks.

Current Recommendations

• The concern from the WHI study has subsided, though doctors no longer routinely prescribe HRT to protect against heart disease, according to the Mayo Clinic. Continued in-depth review of the WHI data found that there are some benefits, particularly to those in early menopause.

  A new study, the Kronos Early Estrogen Prevention Study, reported preliminary results that suggest taking HRT when menopause begins may offer protection against heart attack. This research study won't be complete for several years, however.