I Am Nearing Menopause. Is There Any Role For Hormone Replacement Therapy In The Prevention Of Heart Disease?

— -- Question: I Am Nearing Menopause. Is There Any Role For Hormone Replacement Therapy In The Prevention Of Heart Disease?

Answer: As you near menopause, this is a great time to reassess your health -- your overall heart health, your bone health, and your lifestyle. So this is a time to talk to your doctor about this very question.

There's been a lot of confusion about hormone therapy as it relates to menopause, and a lot of confusing messages that have come out. Part of it started back when we thought that hormones were good for the heart -- and actually, cardiologists were prescribing them as recently as five or ten years ago. But now we know, through some good trials, that hormone therapy added after menopause has not been shown to reduce the risk of heart attack. And it actually, in some instances, can increase the risk of heart attack and stroke.

So what should you do? You should ask some important questions. Our current recommendations are that you not start hormone therapy, particularly estrogen therapy, solely for reducing your risk of heart attack or developing coronary artery disease. On the other hand, we know a lot about these hormones because of some very large studies, including the Women's Health Initiative, which showed what the risks are and what the benefits are. And we know that hormone therapy is the most effective way to reduce the hot flashes and the symptoms of menopause. It protects bones. It prevents fractures. So there are some good reasons to use it.

So when you sit down with your doctor at the time of menopause or in the perimenopausal period, you want to talk about what are your cardiac risks -- blood pressure, and smoking, and family history. Where is that risk coming from? Then you want to talk about what is your bone risk, and what symptoms that you might have, as well as your thoughts on taking hormone therapy. And once you've reached that time of menopause, making a decision based on those risks and benefits, but not with the primary aim of preventing a heart attack, because we don't have good data.

I will say that we have a lot of studies that are going on to help us answer that question, such as the Krebs Trial, which is looking at young women at the time of menopause and randomizing them, which means some women will get no hormones, some will get hormones -- and we'll see how they do. But until those are in, I think that you have to weigh all of your risks, all the potential benefits from estrogen, and particularly your symptoms. And then you use hormones at the lowest dose that is effective for the shortest time as you need it for those symptoms.

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