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Hormone Therapy: Heartening News

Estrogen Doesn't Harm, Seems to Protect Hearts of 50+ Women
By
WebMD Health News
Reviewed by Louise Chang, MD

Estrogen Heart Risk

June 20, 2007 - Estrogen protects the hearts of women who take the hormone early in menopause, new data from the Women's Health Initiative (WHI) suggest.

"This is another level of evidence for younger women that estrogen does not harm the heart and may have a heart benefit," study researcher JoAnn E. Manson, MD, PhD, chief of preventive medicine at Harvard's Brigham and Women's Hospital, tells WebMD.

During menopause, a woman's ovaries stop making estrogen. Many women develop life-disrupting symptoms such as hot flashes and night sweats. Estrogen replacement is the most effective treatment for these symptoms. Women with an intact uterus risk uterine cancer from this treatment unless estrogen is balanced with another hormone, progestin.

The new findings come from a WHI substudy of women who had had a hysterectomy and thus received estrogen-only hormone treatment (Premarin, in the WHI study). But Michelle Warren, MD, says that women taking combination hormone therapy do not need to worry about increased risk of heart disease -- provided they start treatment soon after menopause.

"I don't think that women with or without a uterus need to worry about this issue [of heart disease risk]," Warren said at a news conference.

Warren, medical director of the Columbia University Center for Menopause, Hormonal Disorders, and Women's Health, has studied the timing of menopausal hormone therapy but was not involved in the WHI. The news conference was sponsored by Wyeth, which makes Premarin and Prempro (combined estrogen and progesterone), the two drugs studied in the WHI.

Despite the findings, Manson stresses the fact that hormone therapy is intended only for the short-term relief of menopausal symptoms and not as a long-term treatment to prevent heart disease. An editorial accompanying her report in the June 21 issue of the Journal of the American Medical Association agrees.

"It remains important ... to continue to emphasize that hormone replacement therapy should not be considered as a strategy to prevent cardiovascular disease in women," write Michael E. Mendelsohn, MD, and Richard H. Karas, MD, PhD, of Tufts University in Boston.

But Mendelsohn and Karas also agree with Warren, who says that the initial reports from the WHI unduly frightened younger menopausal women.

"Unfortunately, the initial WHI results were unfairly generalized, creating widespread concern that hormone replacement therapy is neutral or even harmful, with respect to cardiovascular disease, in all women," Mendelsohn and Karas write. "[The current study] and other recent studies support the hypothesis that estrogen can reduce the risk of coronary heart disease in women 50 to 59 years old, which should help clarify this confusion."

Hormone Therapy: Timing Key to Benefit

The WHI trial was designed to see whether long-term treatment with combined estrogen plus progestin (Prempro) (or, for women who have had hysterectomies, estrogen alone (Premarin)) offered health benefits after menopause. The study enrolled women up to age 79.

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