Hormone replacement therapy and your heart

Are you taking — or considering — hormone therapy to treat bothersome menopausal symptoms? Understand potential risks to your heart and whether hormone therapy is right for you.

By Mayo Clinic Staff

Long-term hormone replacement therapy used to be routinely prescribed for postmenopausal women to relieve hot flashes and other menopause symptoms. Hormone replacement therapy was also thought to reduce the risk of heart disease.

Before menopause, women have a lower risk of heart disease than men do. But as women age, and their estrogen levels decline after menopause, their risk of heart disease increases. In the 1980s and 1990s, experts advised older women to take estrogen and other hormones to keep their hearts healthy.

However, hormone replacement therapy — or menopausal hormone therapy, as it's now called — has had mixed results. Many of the hoped-for benefits failed to materialize for large numbers of women. The largest randomized, controlled trial to date actually found a small increase in heart disease in postmenopausal women using combined (both estrogen and progestin) hormone therapy. For women in this study using estrogen alone, there was no increased risk in heart disease.

Other studies suggest that hormone therapy, especially estrogen alone, may not affect — or may even decrease — the risk of heart disease when taken early in postmenopausal years. However, these studies can be confusing to interpret into practice, since study outcomes can be affected by many factors, such as the ages of the study participants, the time elapsed since menopause and the duration of hormone therapy use. Continued research will help doctors more clearly understand the relationship between menopausal hormone therapy and heart disease.

Risks in perspective

If you're having a tough time with symptoms of menopause but worry about how hormone therapy will affect your heart, talk with your doctor to put your personal risk into perspective. Consider these points:

  • The risk of heart disease to an individual woman taking hormone therapy is very low. If you are in early menopause, have moderate to severe hot flashes and other menopausal symptoms, and are otherwise healthy, the benefits of hormone therapy likely outweigh any potential risks of heart disease.
  • Your individual risk of developing heart disease depends on many factors, including family medical history, personal medical history and lifestyle practices. Talk to your doctor about your personal risks. If you're at low risk of heart disease, and your menopausal symptoms are significant, hormone therapy is a reasonable consideration.
  • Risk differs for women with premature menopause or premature ovarian failure. If you stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure), you have a different set of heart and blood vessel (cardiovascular) health risks compared with women who reach menopause near the average age of about 50. This includes a higher risk of coronary heart disease. If you have premature ovarian failure, you'll likely be given hormone therapy to protect against heart disease.

Menopausal hormone therapy risks may vary depending on:

  • Whether estrogen is given alone or with a progestin
  • Your current age and age at menopause
  • The dose, type of estrogen and route, or how you take it (oral, transdermal, transvaginal)
  • Other health risks, such as your family medical history and cancer risks

Who should not take hormone therapy

If you've already had a heart attack, menopausal hormone therapy is not for you. If you already have heart disease or you have a history of blood clots, the risks of hormone therapy have been clearly shown to outweigh any potential benefits.

July 09, 2015 See more In-depth