Hormone Therapy for Menopause Doesn't Reduce Heart Disease Risk

New research looks at potential benefits of hormone therapy for postmenopausal women. FG Trade/Getty Images

• Hormone treatment for menopause can help reduce symptoms, but it won’t reduce the risk of heart disease.
• Previous studies found postmenopausal women taking hormone therapy had a lower risk of heart disease.
• This new research finds that hormones may not have a protective effect on the heart.

New research has found that hormone therapy doesn’t appear to reduce the risk of cardiovascular disease in postmenopausal women. 

Around the start of the study, in 1993, multiple observational studies had suggested that postmenopausal women who took hormone therapy had lower risks of developing coronary heart disease. 

It was believed that the decline in estrogen during and after menopause triggered metabolic changes that upped the risk of cardiovascular disease.

As a result, many physicians prescribed hormone therapy to women in both early and late menopause to prevent cardiovascular disease.

The study, published in JAMA Wednesday, adds to growing evidence suggesting that hormone replacement therapy is, contrary to previous beliefs, not useful in preventing heart disease in postmenopausal women. 

“Because of this, we have recommended against the use of hormone replacement therapy for heart disease prevention for quite some time now,” Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, told Healthline. 

Chen was not involved in the study.

Hormone therapy had no major effects on heart health

To understand the effects associated with menopausal hormone therapy, the Women’s Health Initiative conducted multiple clinical trials that tracked the health of 68,132 postmenosual women, between the ages of 50 to 79, from 1993 to 1998. Women were followed up for up to 20 years.

The report found that, compared to women who took a placebo, those who took conjugated equine estrogens (CEE) had a 6% decrease in coronary heart disease and a 3% decrease in myocardial infarction or heart attack, which the researchers say is not statistically significant. 

Additionally, those who took CEE had a significantly higher risk of stroke and a higher, but not statistically significant, risk of pulmonary embolism.

It’s worth noting that current versions of hormone therapy include lower doses and transdermal modes of delivery that may reduce the risk of stroke and embolism.

According to Supreeti Behuria, MD, a cardiologist at Staten Island University Hospital, this research corroborates what physicians have known: “that for postmenopausal woman, menopausal hormonal therapy does not prevent cardiovascular diseases.”

The findings do not support the use of CEE for preventing coronary heart disease or other chronic diseases in postmenopausal women, the paper states.

“These WHI trials have greatly contributed to our understanding of how hormone replacement therapy affects future cardiovascular risk in postmenopausal women,”Chen said. 

How hormone therapy can help women during menopause

Based on the results, doctors should not be routinely prescribing hormonal therapy to postmenopausal women with the goal of preventing cardiovascular disease, says Behuria.

Per the report, menopausal hormone therapy is best used to treat bothersome vasomotor symptoms such as hot flashes in women in early menopause who don’t have any conditions that could be exacerbated by hormone therapy.

Hormone therapy is commonly used when severe menopausal symptoms affect people’s quality of life, adds Chen.

That said, “the decision to start therapy should be made on an individualized basis and should take into account someone’s age as well as their risk for developing heart disease,” Chen said. 

Behuria would like future trials to investigate the cardiovascular effects of newer formulations of hormone therapy.

Until then, the recommendations for lowering the risk of heart disease in postmenopausal women are the same as those geared toward the general public. 

“Eat a heart-healthy diet, get plenty of exercise, maintain a healthy weight, avoid tobacco and alcohol, get good sleep, and watch your blood pressure, blood sugar, and cholesterol levels,” Chen said. 

The bottom line: 

New research has found that hormone therapy doesn’t appear to reduce the risk of heart disease in postmenopausal women. The report adds to growing evidence suggesting that hormone replacement therapy is, contrary to previous beliefs, not a useful heart disease prevention tool.