Hormone Therapy and Menopause – are you at risk for heart disease?

Northwestern Medicine
Women's Health February 02, 2021
Kristi Tough DiSapri, MD, director of the Program for Women’s Bone Health at the Northwestern Medicine Center for Sexual Medicine and Menopause, provides updates to recent recommendations regarding Menopausal Hormone Therapy and cardiovascular disease risk factors.

What we know: 
Menopausal Hormone Therapy (HT) is indicated for treatment of hot flashes, night sweats, moderate to severe vaginal dryness (GSM) and prevention of osteoporosis and fractures. The benefits of HT outweigh the risk in women who start HT less than age 60 or less than 10 years since the menopausal transition. Women who undergo early natural or surgical menopause benefit from cardiovascular and cognitive risk reduction while taking HT. Menopause is 12 months without a menses (bleeding) or surgical removal of ovaries. In the US, the average age of natural menopause is 50-51 years.

Changes in body fat deposition, lipids and arteries/vascular health are associated with menopausal transition. Sleep disturbance and depressive symptoms may be related to hormonal fluctuations and have been associated with increased risk of cardiovascular disease. 

What is new: 
The American Heart Association and American College of Cardiology released new guidelines about the connection with between menopause and cardiovascular risk factors. More data is proving a connection between changes in lipids (increased LDL) , metabolic syndrome and changes or narrowing in arteries which occur during menopause transition. 

Women presenting with severe hot flashes have more subclinical atherosclerosis and cardiovascular risk factors. 

What this changes: 
The new guidelines reinforce the “timing hypothesis” that taking HT early within the menopause transition has a favorable effect on the cardiovascular factors that contribute to women’s increased risk of heart disease after menopause. 

In addition, addressing vasomotor symptoms is recommended. Hot flashes may be a vital sign for cardiovascular risk. And offering prevention strategies that may include FDA approved HT in appropriate patients may be considered part of prevention strategies alongside recommendations for aggressive lifestyle modifications ( such as healthy diet and adequate exercise)  

Clinical relevance: 
In addition to treating bothersome night sweats, hot flashes or genito-urinary syndrome of menopause (also referred to as vaginal dryness) , conditions such as osteoporosis (and associated fractures), diabetes, certain cancer (such as colon) and risk of dementia are prevented in midlife women taking of hormone therapy.  More evidence is reassuring that HT will reduce cardiovascular risk in women.  It is important particularly for women with the above symptoms to discuss their individual risk/benefit of HT with an informed menopause provider. 

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