News 'flash' for women: the latest findings on hormone therapy for menopause & heart disease

The Bottom Line

  • For many women, hormone therapy does not protect against heart disease and may increase the risk of stroke and blood clots.
  • Consider your own circumstances, risks and preferences when deciding whether you should use hormone therapy for relief of menopause symptoms.
  • Patient decision aids can help you make an informed choice about hormone therapy to treat menopause symptoms.

When it comes to drugs and other medical treatments, what a difference a decade makes. For instance, take hormone therapy– or rather don’t! – at least not until you have all the latest facts based on current research evidence.

Hormone therapy for menopausal women involves taking prescribed doses of estrogen or a combination of estrogen and progesterone to help replace levels which typically lower during menopause (1). This helps ease symptoms associated with menopause, such as itchy and/or dry skin and the dreaded hot flashes and night sweats (1). Remember the TV ad with the woman trudging out to the backyard in the midst of a snowstorm to uncover the air conditioner? Not so funny to those who can relate to her anguish!  

Hormone therapy was also believed to help protect against some serious age-related conditions including heart disease (2). Since women’s risk for heart attack and stroke increases after menopause (2) it seems like good timing to use hormones to ward off both menopause symptoms and heart problems. Can’t hurt, right?

Well as it turns out, it can. In the past 10-15 years, a few large-scale studies have focused on the impact of hormone therapy, including one as part of the Women’s Health Initiative, a long-term U.S. based health study (3). The results of that randomized controlled trial challenged long-held assumptions, showing that not only was there no evidence of any protective benefits of hormone therapy for heart health, it can actually increase the risk of heart disease for some women (3).

Since then, many more studies have been conducted in an effort to either confirm or refute those game-changing findings (4). A 2015 update of a previous systematic review included the results of six new studies for a total of 19 high quality randomized controlled trials involving more than 40,400 postmenopausal women (2). About half were prescribed hormone therapy – either estrogen alone or estrogen combined with progesterone – and compared with those in control groups who were given either no treatments or a placebo.

What the research tells us

The review found that hormone therapy did not lower the risk of death from heart disease for postmenopausal women. There was evidence that hormone therapy increased the risk of stroke, clots in the arms or legs (venous thromboembolism) and clots in the lungs (pulmonary embolism) by a small degree (2). For example, the increased risk of stroke was 6 per 1000 women – in other words, 165 women would be treated before an additional stroke occurred.

Additionally, a new systematic review from 2017 which evaluated 22 randomized controlled trials found that combination hormone therapy increased the risk of heart attack to between 3 and 7 per 1000 people and the risk of blood clots to between 4 and 11 per 1000. Risks of stroke, breast cancer, gallbladder disease, and death from lung cancer all increased with use of combination hormone therapy (5).

Does this mean all women should avoid hormone therapy? Not necessarily. For some, the benefits (relief from menopause symptoms) may outweigh the risks, especially as risk varies depending on age, general health, the amount of time since menopause, and other health/lifestyle factors (2). In fact, younger women and those who had more recently gone through menopause showed a slightly lower risk of dying and of heart disease when they used hormone therapy. They still faced increased risk of clots and stroke, however.

For the time being, it is not recommended that anyone take hormone therapy solely to prevent heart disease.

Studies like these underline the importance of working with your doctor and having up-to-date, complete and accurate information – including any side effects or potential harms – before starting any new medication, therapy or procedure. 

Need help making a decision about menopause treatment?

Check out this decision aid on the topic: Menopause - Should I take hormone therapy (HT)?

Want to keep your heart healthy and strong?

Browse through some of our other blogs to learn what you can do

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  1. Informed Health Online: Hormone therapy for menopause symptoms [Internet] 2012. [cited Feb 2016]. Available from: http://www.mcmasteroptimalaging.org/full-article/b53f16fffce1b80a58aedd794a9fea12?hl=hormone+therapy
  2. Boardman HM, Hartley L, Eisinger A et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015. (3):CD002229. doi: 10.1002/14651858.CD002229.pub4.
  3. Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002; 288(3):321–33.
  4. Main C, Knight B, Moxham T et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2013; (4): CD002229. doi: 10.1002/14651858.CD002229.pub3.
  5. Marjoribanks J, Farguhar C, Robert H, et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017; (1):CD004143. doi: 10.1002/14651858.CD004143.pub5. 

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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