Over the years there has been quite a lot of conflicting information regarding estrogen, Hormone Replacement Therapy, and cardiovascular risk, like heart attack, strokes, and blood clots. And it seems like for every doctor who tells you it’s safe, another doctor comes out saying it’s not. I understand how confusing it all is, and I understand that ladies want to get rid of their hot flashes, night sweats, foggy heads, vaginal dryness, mood changes, irritability, and other menopausal symptoms, but nobody wants to risk getting a blood clot or having a heart attack. So, what is the truth about cardiovascular risk when taking estrogen and why is it so confusing?
Since the 1960’s there have been different forms of estrogen available on the market. The first was taken from the urine of a pregnant mare, and the second was combined with progesterone. Now we have bio-identical hormones that are derived from plant sources, and are bio-chemically exactly the same as the hormones your body would produce, but the warning label on the side of the package still includes all the safety information associated with the previous kinds of estrogen that were not. All of the side effects and warnings from all the different types of estrogen are lumped together, making it really hard to makes sense of it all.
So, what do we know now? We know that safe, bio-identical hormones can actually help your cardiovascular risk by slowing the progression of atherosclerosis and helping keep your coronary arteries clear of plaque build-up. However, there are two very important things to note. The first is that if you wait more than 6 years after the onset of menopause to begin Hormone Replacement Therapy, there is little or no cardiovascular benefit. You will still be able to get rid of the hot flashes and other menopausal symptoms, but there would be no added cardiovascular benefits. Additionally, women who are already high-risk for cardiovascular disease/heart disease (those who have high blood pressure, high cholesterol, poor HDL/LDL cholesterol ratio, are overweight, or have large waist measurement, especially those who have a combination of several of these) have an INCREASED risk of heart problems during that first year on Hormone Replacement Therapy. It is absolutely critical that you tell your doctor if you are high-risk for cardiovascular disease. If you are a high-risk patient, the risks of Hormone Replacement Thearpy may outweigh the benefits and other treatments will need to be considered.
If you are being prescribed Hormone Replacement Therapy and are concerned about your heart health please make an appointment to come see me. I am happy to discuss benefits and risks with you or help you determine your cardiovascular risk.