Estrogen May Aid Heart for Women in 50s

Hormones taken to relieve hot flashes also may have some heart benefits for women in their 50s. Women in the study group took estrogen only. They started taking it soon after menopause. After seven years, they had less calcium (plaque) in their arteries than similar women who were given sugar pills. Less plaque buildup usually means lower risk of heart attack. The Associated Press wrote about the study June 21. It was in the New England Journal of Medicine.

What Is the Doctor's Reaction?

If it seems like you've been getting mixed messages about hormone replacement therapy (HRT) lately, that's because you have. In fact, the health effects of HRT are mixed – they differ for different people. Short sound bites describing the health effects of HRT often add to the confusion.

Until recently, HRT was thought to help the heart and overall health. But in 2002, the Women's Health Initiative (WHI) published the best study to date on HRT. It did not confirm cardiac benefit. In fact, heart attack risk seemed to increase in the first few years of therapy.

HRT was also associated with an increased risk of breast cancer, blood clots and stroke. Overall, the risks of HRT appeared to rule out routine use. Soon, millions of women stopped taking HRT.

Now we're hearing that HRT may be good for the heart after all, at least in some cases. The latest news comes from a new WHI study. Researchers found a benefit for women who started taking estrogen soon after menopause and continued it for about seven years. They ended up with less calcium (plaque) in their coronary arteries than women taking a placebo. In general, this predicts a lower rate of cardiovascular disease, including heart attack.

This isn't the first WHI study that found some women who appeared to have better heart health after using HRT. In 2006, WHI researchers found that heart attack risk fell slightly among women who started taking estrogen between the ages of 50 and 59.

So, should women consider taking HRT? The answer is a resounding "maybe." That's because it depends on:

• Timing – The risks seem lower when HRT is started soon after menopause.

• Type and dose of HRT – Estrogen does not have the same risks as estrogen plus progesterone. Risks may vary with dosage as well.

• Prior hysterectomy – Estrogen alone is an option only for women who have had their uterus removed. Estrogen increases the risk of uterine cancer. The combination of estrogen and progesterone does not increase this risk.

• Other cardiovascular disease risk factors – These include smoking and high blood pressure, among others. In general, the more risk factors a woman has, the riskier it is to take HRT. It's worth noting that in this latest research, only 12% of study subjects were smokers. Only 10% had high cholesterol levels.

So, where does this leave us? In my view, the evidence supports the following general conclusions:

• Women should not take HRT solely for its potential to protect the heart. It is not a reliable way to do this. Most women have better options.

• HRT appears to be riskier when taken long-term by women older than 60.

• Women should not take HRT solely to strengthen bones. HRT can slow bone loss after menopause. But there are safer and more effective options.

• The risk level may be acceptable for short-term HRT use to treat severe hot flashes soon after menopause. For women under age 60, estrogen alone may even be good for the heart.

This new research should not lead to widespread resumption of HRT. However, it should at least reassure younger women who take estrogen or are considering it for hot flashes.

What Changes Can I Make Now?

HRT probably would have faded from the scene years ago if it wasn't so effective for hot flashes (or if there were good alternatives). For women with severe symptoms, HRT can provide a major improvement in quality of life. Talk to your doctor about your risk profile and whether the risks of HRT are worth the potential benefits.

It's also worth considering non-hormonal approaches for hot flashes. Some women have found relief by taking certain antidepressants or blood pressure medicines. Black cohosh is a popular herbal therapy for hot flashes. However, a recent study found that it was no better than a placebo.

You can improve heart health without HRT. Here are some of the best ways:

• Improve your diet. Eat more fruits, vegetables, fish, fiber and whole grains. Limit salt, saturated fat and trans fat.

• Get more exercise. Gradually increase your activity level. Your goal should be to exercise at a moderate intensity for at least an hour most days of the week. This especially helps if you are trying to lose weight or keep it off.

• Get your blood pressure, blood sugar and cholesterol checked regularly. Keep them in a healthy range with diet, exercise and, if necessary, medicines.

• Don't smoke. If you have trouble quitting on your own, discuss smoking cessation programs with your doctor.

• Consider daily aspirin use. New guidelines suggest that all women 65 or older should consider taking up to 325 milligrams of aspirin each day. This is especially important for women at high risk, such as those who already had a heart attack. Regular aspirin use has risks, so talk with your doctor first.

What Can I Expect Looking to the Future?

Researchers will continue looking for the factors that could make HRT acceptably safe. You also can expect research on new ways to treat hot flashes. If a safe and highly effective treatment is found, HRT will likely disappear.

Until that happens, look for updates to the WHI studies of HRT and pay attention to the "fine print." It may turn out that a brief course of HRT can improve the quality of your life at minimal or no risk. Depending on your age and the type of HRT, it might even help your heart.

Copyright Harvard Health Publications - 2007