Spotlight On: Hormones and your Heart

Does hormone therapy harm or protect women's hearts?

JoAnn V. Pinkerton, M.D., of the University of Virginia Health System, is a board member of the North American Menopause Society and a certified menopausal specialist. For UVA's Club Red members, she answers questions on what science has revealed about the effect of hormone therapy on a woman's heart.

Common forms of hormone therapy (pills that combine estrogen and progesterone and those containing only estrogen) fail to protect women's hearts and blood vessels, if given to women after menopause. This conclusion comes from recent large-scale studies known collectively as the Women's Health Initiative. These studies overturned many of the long-held beliefs about the health benefits of supplementing the heart-protecting hormones that women lose as they age.

The Women's Health Initiative did not show that hormone therapy definitely damages the heart. However, hormone therapy is NOT recommended solely for heart protection in women of any age. It is possible that hormone therapy is protective if started at menopause for women who are having hot flashes. This theory is being tested in a national study called the KEEPS trial.

I have menopausal symptoms that significantly impact my life. Should I take hormone therapy?

No woman should ever suffer from debilitating menopausal symptoms such as night sweats and hot flashes. It's important to always consult your health care provider about the best treatment for you. With that said, the latest scientific findings back up current recommendations that women take the lowest HT dose possible, over the shortest time possible, to relieve moderate or severe menopausal symptoms. There are also non-hormonal prescription medications that may offer relief to women who can't or shouldn't take hormone therapy.

For vaginal dryness, you can use vaginal moisturizers. Water-soluble vaginal lubricants reduce pain during sexual intercourse. If these are not enough, then small amounts of vaginal estrogen (available as vaginal cream, ring or tablet) can be helpful and without much absorption into the body.

The Women's Health Initiative and other studies confirm that hormone therapy continues to have a role in the menopausal process for many women, particularly those with early menopause or significant menopausal symptoms.

What is the biggest danger of taking hormones?

Because hormone therapy may increase a woman's risk of blood clots and stroke, you should definitely stop hormone therapy if you have had a heart attack, stroke or stroke-like symptoms, or if you have developed a vein clot. You probably should also stop hormone therapy if you need to be immobilized because of a broken bone or major surgery. Being immobilized increases your chances of forming a blood clot.

The Women's Health Initiative found an increase in blood clots (deep vein thrombosis) in the first one to two years of taking combination hormone therapy. Fortunately, the overall risk of blood clots associated with taking estrogen alone or estrogen along with progesterone is low, and even lower in women less than 60 years of age.

It's important to know that the higher the dose of estrogen, the higher the risk of clotting. The doses of estrogen used in postmenopausal hormone therapy are significantly lower than those used in birth-control pills. For this reason, if you have had a clot in the past, but do not currently have a blood clot or inflammation in the deep veins in the legs, you may be able to use hormone therapy to relieve menopausal symptoms.

Do you have recommendations about other hormone alternatives (lower-dose estrogens, micronized progesterone, natural hormones)?

There are still no definitive answers on the health effects of other types and doses of hormone therapy now becoming available. Transdermal hormones (including patches, creams or gels) avoid stimulating the liver to produce more clotting factors and, therefore, have a lower risk of blood clots. Theoretically, lower doses appearing on the market should be safer but we lack long-term studies to prove this.

Without more research data, it is not possible to make specific recommendations about other hormone medications, including compounded "natural" products. Without clinical trial data, one cannot assume that alternative estrogen plus progesterone treatments have the same risks, or are any safer, than those studied in large-scale clinical trials.

Are "bioidentical hormones," which I heard can be tailored to my needs by compounding pharmacists using salivary testing, any safer?

The estrogens in both hormone therapy approved by the Food and Drug Administration and compounded hormone therapy (not FDA-approved) actually all start from the same soy and yam plants and are chemically changed in the same labs. FDA-approved products, however, must meet certain standards of scientific testing. I advise caution in the use of compounded products because regulatory oversight is lacking for quality, purity and batch-to-batch consistency of ingredients.

What are the best ways I can keep my heart healthy during and after menopause?

Exercise, beginning at any age, continues to be strongly recommended for its many benefits, including significantly reducing your chances of getting heart disease and breast cancer (estrogen-only therapy increases a woman's risk of breast cancer). Menopause is a great time to evaluate your risks and develop a plan to prevent or delay medical illnesses. Make menopause a transformative time in your life--healthy aging depends on eating right and staying active--whether or not you need medication.

Find out questions to ask at your next appointment