Hormone Therapy: Heartening News
Estrogen Doesn't Harm, Seems to Protect Hearts of 50+ Women
Hormone Therapy: Timing Key to Benefit continued...
"The timing issue is absolutely crucial -- below the age of 60, probably right at the time of menopause, is when women want to start hormone therapy," Hodis says. "Early initiation of hormone therapy ... is quite efficient at reducing coronary artery disease. Taken together with previous reports ... we see that with estrogen-only hormone therapy, we have not only seen a reduction in coronary heart disease and overall mortality but also no risk of breast cancer, stroke, and other adverse outcomes."
"My patients are more worried about hormone therapy causing breast cancer than about heart disease," Warren says. "But there is no increased risk of breast cancer with estrogen alone, only with estrogen plus progesterone, and the risk is tiny."
Statements from leading menopause societies largely support the opinions expressed by Warren and Hodis.
"We are clearly learning that the benefits of estrogen in young, healthy, postmenopausal women outweigh the risks," says Robert W. Rebar, MD, executive director of the American Society for Reproductive Medicine.
"Since most, if not all, women do not start hormone therapy at an old age, safety concerns on its possible adverse cardiac effects are actually invalid for the vast majority of hormone users," reads a statement from the International Menopause Society. "In fact, treatment seems to be associated with reduction of risk for coronary artery disease if initiated early."
Hormone Therapy: How Long?
Hormone therapy with any of the several available estrogen/progesterone or estrogen-only products is currently intended only for relief of moderate to severe menopausal symptoms. Current recommendations call for the products to be used at the lowest effective dose, for the shortest possible time.
"There are some risks of hormone therapy, and that is why it is important for women not use these hormones expressly for reduction of heart disease risk," Manson says. "There is increased risk of blood clots in the legs, and of breast cancer. Now we are treating women only for moderate to severe menopausal symptoms, and only for three years. In that scenario -- recently menopausal woman in good cardiologic health with severe menopausal symptoms -- for them it is much more likely the benefits will outweigh the risks."