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Menopausal hormone therapy and your heart
Borrowers who practice responsible
The findings in brief
The bottom line:
Now what?


A closer look
A closer look

The Women’s Health Initiative study that yielded the disquieting results about HRT was a long-term trial of Prempro, a pill containing 0.625 milligrams of equine estrogen and 2.5 milligrams of medroxy-progesterone acetate.

Starting in the mid ‘90s, 16,608 healthy women ages 50 to 79 who had not had a hysterectomy were randomly given the pill or a placebo and monitored by doctors at 40 clinics throughout the United States. The trial was directed by the National Heart, Lung, and Blood Institute—part of the National Institutes of Health—and was slated to continue until 2005.

Prempro was chosen because it is the most commonly prescribed form of HT. The study didn’t evaluate other HT regimens, like combining one estrogen-only pill with one progestin-only pill, nor did it give HT to women in different dosages or administer it by patch, cream or vaginal ring.

You probably know that a major clinical trial of hormone replacement therapy, or menopausal hormone therapy (HT), was halted in 2002. Researchers with the trial, a component of the Women’s Health Initiative, determined the drug had increased the risk of breast cancer, heart attacks and stroke in participants beyond the study’s safety margins. (See “A Closer Look.”)

And since then you’ve most likely heard or read numerous opinions about whether you should still take, or even consider, hormones for menopausal symptoms and to help fight osteoporosis—two areas where strong evidence suggests HT remains effective.

If you’re feeling overwhelmed by the HT debate, you’re not alone. To make an informed judgment about HT’s possible value to your well-being, talk to your doctor about the latest findings and how they affect you.

The findings in brief

The study evaluated estrogen-plus-progestin therapy only. Results after 5.2 years showed it could be expected to cause seven more heart attacks, eight more strokes, 18 more blood clots and eight more cases of breast cancer per 10,000 women each year than in women not taking this form of HT.

The bottom line:

  • Estrogen-plus-progestin therapy, which has been touted as heart-protective since the 1960s, actually may be detrimental to cardiovascular health.
  • Worries that HT increases breast cancer risk may be justified.
  • The risk of heart disease and breast cancer seems to rise after five years of use, so short-term hormone therapy to relieve menopausal symptoms such as hot flashes and vaginal dryness (with your doctor’s approval) may remain an option for some women.

Now what?

As your body begins producing less and less estrogen during menopause, it may in fact be unwise to try replacing its heart-healthy benefits with HT. Where does this leave HT, you and your heart? While deciding, consider these points:

  • Help reduce your heart-disease risk without HT by not smoking, keeping your blood pressure under 120/80 mm Hg, maintaining a healthy weight, eating plenty of fruits and vegetables and low-fat foods, getting regular aerobic exercise and keeping your cholesterol in check. Other heart-protective alternatives include aspirin therapy, statins that lower high cholesterol and antihypertensives to lower high blood pressure.
  • Consider alternatives like Evista (raloxifene), a so-called SERM (selective estrogen receptor modulator). Designed to fight osteoporosis, it also lowers LDL cholesterol.
  • Ask if you’d benefit from nonhormonal treatments for osteoporosis such as Fosamax, Actonel and Boniva, drugs that preserve bone mass and may reverse bone loss.
  • Remember that only you and your doctor can fully evaluate all the different aspects of HT and menopause, and then decide what’s best for your health.

To read more on the study, visit www.nhlbi.nih.gov/whi.