July 30, 2014
News Review From Harvard Medical School -- Study: Early Hormone Therapy OK for Heart
Short-term hormone therapy for menopause symptoms is unlikely to harm the heart, a new study suggests. An earlier, large-scale study linked hormone replacement therapy with higher risks of heart disease and stroke. But the women in that study were well past the age of menopause. The new study included 727 women, ages 42 to 58. They were no more than 3 years past menopause. All were at low risk of heart disease. The women were randomly divided into 3 groups. One group took pills containing low doses of the hormones estrogen and progesterone. Another group took progesterone pills and wore estrogen skin patches. The third group received placebo patches and pills. They contained no hormones. Everyone had ultrasound tests to show the thickness of artery walls in the neck. Another test looked at new calcium deposits in arteries around the heart. These are tests for atherosclerosis, the cause of most heart attacks and strokes. After four years, researchers did the same tests again. Increases in artery thickness and calcium deposits were about the same for all three groups. The journal Annals of Internal Medicine published the study. HealthDay News wrote about it July 28.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Until 12 years ago, doctors often prescribed hormone therapy for women after menopause. This treatment included estrogen. It was sometimes combined with progesterone. Hormone therapy was, and still is, the most effective treatment for symptoms of menopause, such as hot flashes and vaginal dryness. We also believed that it decreased the risk of heart disease, stroke, dementia and osteoporosis.
That was before results of the landmark Women's Health Initiative study were released in 2002. They showed that taking estrogen and progesterone after menopause may increase women's risk of stroke, heart disease, blood clots and breast cancer. Hormone therapy does slow bone thinning. It decreases the risk of osteoporosis.
The average age of the women in this major study was 63. This is many years past the age women go through menopause. So experts began to question whether hormone therapy had the same risks for younger women.
More recent studies have looked at hormone therapy started at or shortly after menopause. Study results suggested that it did not increase the risk of heart disease and stroke. In fact, some studies showed that hormone therapy started right after menopause might actually decrease risk. However, they were observational studies. They compared health results in women who did or did not choose to take hormone therapy prescribed by their doctors. These types of studies can only suggest a link between early hormone therapy and lower risk of heart disease and stroke. They don't prove cause and effect.
The new study is a randomized controlled trial. This is considered the "gold standard" type of study. The study group consisted of women aged 42 to 58. All of them had their last period no more than 3 years before the study began. They were randomly assigned to 1 of 3 groups:
- Estrogen with oral progesterone 12 days per month
- Estrogen skin patch plus progesterone pills 12 days per month
- Placebo -- patch and pills with no active ingredients
The researchers gave all the women tests that looked at thickness of the carotid arteries in the neck and calcium deposits in the heart arteries. These tests are excellent ways to assess the amount of fatty deposits in arteries. These deposits are the cause of most heart attacks and strokes.
The researchers looked at how much change occurred in the arteries over four years. Women in all three groups showed similar small increases in fatty deposits.
Based on this study, hormone therapy started shortly after menopause did not increase or decrease the risk of stroke or heart attack compared with no hormone therapy.
What Changes Can I Make Now?
These results add more reassurance for women considering hormone therapy to treat symptoms of menopause. Short-term therapy does not increase your risk of heart attack or stroke.
Short-term hormone therapy also does not increase breast cancer risk in most women. But even limited hormone therapy can increase your chance of developing a blood clot in the leg.
Estrogen is the hormone that relieves symptoms such as hot flashes and vaginal dryness. If you still have a uterus, most doctors recommend taking progesterone or another type of progestin with the estrogen. This reduces the risk of uterine cancer.
Which estrogen to take? Estradiol pills or patches appear to have a lower risk of blood clots than conjugated estrogen. Symptom relief is similar.
You may still be reluctant to use hormone therapy. Or you may have a medical reason that you shouldn't use estrogen pills or patches. Here are a few other options for treating menopause symptoms.
- Vaginal estrogen -- A tablet, ring or cream delivers a low dose of estrogen into the vagina. This treatment can help relieve dryness, discomfort during sex and some urinary symptoms.
- Relaxation therapy -- There is some evidence that techniques that help you attain a state of calmness and relieve stress may help with hot flashes. Examples include deep breathing, yoga and meditation.
- Low-dose antidepressants -- Some antidepressant drugs may reduce hot flashes. They include venlafaxine (Effexor), fluoxetine (Prozac), citalopram (Celexa) and escitalopram (Lexapro).
- Gabapentin -- This anti-seizure drug can also help with hot flashes.
What Can I Expect Looking to the Future?
Experts will not change their current advice to women. Hormone therapy should not be taken as a way to prevent chronic medical conditions, such as heart disease. Avoid long-term use of hormone therapy unless symptoms of menopause are severe and other treatments don't help.