Early HRT Doesn't Reduce Heart Risk
Starting Hormone Therapy Around Menopause Offers No Decrease in Risk of Heart Disease
Hormone Therapy and the Heart continued...
Compared to women randomized to the placebo arm of the trial, women who commenced combined hormone therapy within 10 years of menopause had a slight increase in heart disease risk during the first two years of use, but this increase in risk did not reach statistical significance and was considered small.
Perhaps the more important finding was that there was clearly no evidence of a protective effect.
“The available evidence suggests that estrogen plus progestin therapy does not reduce the risk for coronary heart disease during the first 3 to 6 years of use in women who initiated therapy close to menopause,” Toh and colleagues write. “Because the typical duration of use of hormone therapy is short, most women contemplating estrogen plus progestin therapy for the relief of menopausal symptoms should not expect protection against heart disease.”
Is Today’s Hormone Therapy Safer?
Hormone therapy researcher JoAnn Manson, MD, who was a principal investigator for the WHI trial, tells WebMD that women taking hormone treatments today for menopausal symptoms may have a lower risk for treatment-related side effects than the women in the original trial.
That’s because the women who participated in the WHI intervention trial were taking much higher doses of estrogen than women typically take today and they took them for longer periods.
It is generally believed, but has not been proven in clinical studies, that the lower-dose hormone formulations widely used today are safer than the higher-dose formulations used a decade ago.
Many women now use a low-dose hormone patch, which has been shown to have a lower risk for blood clots.
“There is always a trade-off when you take any drug,” says Manson, who is chief of the division of preventive medicine at Boston’s Brigham and Women’s Hospital. “But it is important to point out that heart disease is not common in women around the time of menopause. Their risk is very low.”
Manson agrees with the current recommendation that women experiencing troubling menopausal symptoms take hormones in the lowest effective doses for the shortest duration possible.