How Does Hormone Therapy in Menopause Affect Your Heart?

If you’re in the throes of menopause or perimenopause, you already have a lot going on with your body. Maybe you’re sweaty, or exhausted, or mourning the loss of your sex life, or all the above, and you’re looking for some relief, which you’re told could come in the form of hormone therapy.

But wait, didn’t you hear something about how hormone therapy during menopause is bad for your heart? OK. Before you start to spiral, here’s a look at what’s really going on with hormone therapy, heart health and your beautiful body (that seems to have turned on you).

What is hormone therapy for menopause?

Need a quick rundown on hormone therapy for menopause before we get started? Angela Petlow, ARNP, a reproductive endocrinology and infertility nurse practitioner who is certified by The Menopause Society and works at the Center for Reproductive Health and Fertility at UW Medical Center – Roosevelt can help.

Hormone therapy or HT, which until recently was often referred to as hormone replacement therapy or HRT, is a super effective treatment option for people who are dealing with the unpleasant symptoms of menopause or perimenopause. Therapy typically includes an estrogen and, for those with a uterus, a progesterone to keep the uterine lining from thickening, which can increase your risk of uterine cancer.

“You’re not actually ‘replacing’ natural, ongoing hormones or production of estrogen and progesterone, but instead, treating symptoms with the use of these exogenous hormones — which means they’re produced outside the body,” says Petlow.

According to Petlow, hormone therapy is approved for:

• Symptoms like hot flashes and night sweats.
• Prevention of bone loss. It’s not a treatment for osteoporosis, but it can be used for prevention.
• Premature hypoestrogenism, or low estrogen levels and ovarian dysfunction.
• Premature menopause, which is menopause before the age of 40, or surgical menopause when you’ve had both ovaries removed.

Hormone therapy is generally administered through pills, patches, gels and sprays, but can also be directly applied to just your vagina and vulva by using vaginal creams, tablets, suppositories or rings to help alleviate local symptoms.

What’s the deal with hormone therapy and heart health?

Ok, so there seem to be plenty of good, solid reasons to dip your toe into the hormone therapy pool, which is why the whispers (and shouts) about it being bad for your heart have been such a bummer for menopause-aged women to hear over the years. But just how accurate are those warnings?

To understand, you really need to look back to the Women’s Health Initiative, a landmark clinical trial that was launched in 1991, and over the next few years enrolled over 27,000 postmenopausal women (aged 50-79) to take part in the trial. One of its aims was to test the effects of menopausal hormone therapy, but this part of the trial was abruptly ended in 2002 when the researchers decided that the risks outweighed the benefits. They cited data that showed an increased risk of coronary heart disease, stroke, blood clots in the lungs, and breast cancer in people taking hormone therapy.

However, over the years, the data has been reexamined, with a particular interest in the age of the women involved and how long it had been since they started menopause.

“The initial data didn't break down the different age ranges, so it was just aggregated data,” says Petlow. “And upon further analysis, the data showed more benefits for women who were under age 60 and within 10 years of menopause, with fewer cardiovascular disease events in younger versus older women.”

So basically, if you’re a healthy woman who is within 10 years of your menopause transition, younger than 60 years old and experiencing annoying menopause symptoms, the benefits of hormone therapy outweigh the risks.

The Menopause Society agrees, recognizing the favorable effects that hormone therapy can have on coronary health if started within 10 years of menopause. Now, of course, no two people are the same, so the 10-year rule is a little loose, depending on your own health history, current health issues, etc.

For example, the benefits are less favorable for women who start hormone therapy after turning 60 years old, or who started menopause more than 10 to 20 years ago. They are at a higher risk of coronary heart disease, blood clots and stroke than those who started earlier.

Asking your healthcare team about HT

Wondering if you’re in the sweet spot to explore hormone therapy for your menopause or perimenopause symptoms? Perfect. It’s time to talk to your healthcare team. According to Petlow, here are some great questions to ask:

• Am I a candidate for hormone therapy? Do I fit any of these categories?
• Are you comfortable prescribing hormone therapy? (If not, find someone who is, and who has more knowledge.)
• What is my cardiovascular disease risk, and can you order diagnostic testing to help assess it? (They should be looking at lipids, blood pressure, blood sugars, metabolic health, smoking status, weight, other cardiovascular disease risks, and family health history.)
• Discuss other risks with your doctor, like any history of preeclampsia or eclampsia, hypertension of pregnancy, or gestational diabetes, since those all can increase the risk for cardiovascular disease.

“I love the term precision hormone therapy because it refers to us looking at that individual sitting in front of you, their health history and what's going on with them,” says Petlow. “What are their cardiovascular disease risks? What are their breast cancer risks? Getting some labs to evaluate that, doing some diagnostics, having a thorough conversation about the risks and benefits, and coming to a shared decision — because one 60-year-old is not the same as the next 60-year-old.”

Some last thoughts

What it really comes down to is that your hormone therapy journey (if you choose to accept it) is a personal and unique experience. You don’t need to be scared about exploring the option; you absolutely deserve to have tools like hormone therapy that can make the menopause transition a smoother, less excruciating journey. Just be sure to check in with your healthcare team about which options can help you stay your healthiest.