Menopause and Heart Disease: Is Estrogen Safe for You?
By Judy Couch, FNP-C
February is the month of hearts and love, so it’s no surprise that the American Heart Association picked February to raise awareness of heart disease in women. While many, many women worry about cancer (especially breast cancer), the truth is that heart disease kills more women every year than all other cancers combined.
As a woman passionate about empowering women to take control of their health, I want to review the sometimes confusing literature about menopause and heart disease as they relate to hormone replacement so you feel confident about your health.
Are hormones safe for menopausal women?
It’s important for us to understand what the literature says, and to interpret it in the correct way. The short answer is that yes, estrogen is cardioprotective. The sooner we start using estrogen at the time of menopause, the more protective it is.
So why then do people often hear that estrogen is bad for menopausal women?
Prior to 2002, it was considered unethical to not offer estrogen to women as a hormone replacement after menopause. There were over 40 years of studies that showed that bioidentical hormones were cardioprotective, especially for women if the hormones are used early enough and are appropriately dosed.
In 2002, however, that idea kind of shifted because of one study: the Women’s Health Initiative (WHI). The first arm of the study included women who were in their mid-sixties who were taking synthetic hormones (estrogen, progestins, or medroxyprogesterone acetate). The study found that the combination of those hormones did not show a benefit from a cardiovascular standpoint. Unfortunately, doctors took women off their hormone replacement because they believed it didn’t have any benefits.
The second arm of the same study, however, had a different result. This one focused on women taking synthetic estrogen, ethinyl estradiol, or Premarin. The 11-year followup actually showed quite the opposite: taking hormones are very cardioprotective and did reduce the risk of developing cardiovascular disease, stroke, and other diseases.
Can hormones help prevent heart disease?
Yes! Study after study shows that hormones are most protective in 50 to 60-year-old women, especially when used preventatively. We can’t prevent what has already developed, but if we start hormone replacement right at the same time as menopause, we have a much greater chance of actually preventing the cardiovascular disease from even developing in women.
What are the benefits of estrogen replacement?
There are many benefits of estrogen, but there are three specific benefits estrogen has for your heart health:
- Estrogen has an anti-inflammatory effect. When we decrease the inflammation levels, we decrease the actual development of some of the degenerative diseases of aging.
- Estrogen prevents the development of plaque in our arteries. A metabolite of estradiol, one of our three estrogens, prevents plaque buildup called atherosclerosis.
- Estrogen prevents endothelial dysfunction. This means estrogen increases the lining, decreases the chance of dysfunction, and prevents cardiovascular disease.
Are there more studies I can read?
Many of my patients are interested in further readings to increase their understanding of menopause and heart disease. There are numerous studies out there, but the ones I commonly refer patients to are:
- “A “window of opportunity:” the reduction of coronary heart disease and total mortality with menopausal therapies is age-and time-dependent.” by Howard N. Hodis, MD, and Wendy J. Mack, PhD. Brain research 1379 (2011): 244-252. Keck School of Medicine, University of Southern California, Los Angeles, CA.
- In Perspective: Estrogen Therapy Safely and Effectively Reduces Total Mortality and Coronary Heart Disease in Recently Menopausal Women by Howard N. Hodis, MD, and Wendy J. Mack, PhD. Menopause Manag. 2008 Mar; 17(2): 27–32.
- The impact of early menopause on risk of coronary artery disease (PREmature Coronary Artery Disease In Women – PRECADIW case-control study) by Barbara Lubiszewska et al.Department of Coronary Heart Disease, Institute of Cardiology, Warsaw, Poland. European Journal of Preventive Cardiology February 2012 vol. 19 no. 1 95-101.
- Heart Book by Jeffrey Dach, MD.
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