Hormone replacement therapy (HRT) helps relieve menopause-related symptoms, but for many years, researchers have raised red flags about potential health risks associated with treatment.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
In 1998, HRT got a bad reputation in terms of its effect on women’s hearts. But recent research and analysis has shed new light on the relationship between hormone replacement therapy and heart health. For most women, estrogenic replacement therapy is safe, but proper treatment requires careful analysis on a case-by-case basis.
Symptoms and risks
After menopause or after certain medical conditions, estrogen and progesterone levels fall. Doctors can prescribe estrogen or both estrogen and progesterone together to help you deal with uncomfortable symptoms that can occur during menopause and affect your daily life. A woman’s risk for heart disease increases after menopause, which is why doctors want to understand HRT’s effect on women’s hearts.
Blood clots and heart disease
Researchers at the University of Washington looked at 384 postmenopausal women in the hope of answering an important question: Does the type of HRT treatment impact a woman’s risk of deep vein thrombosis (blood clots) and by association, heart disease?
The results, published in The Journal of the American Medical Association (JAMA), showed that the women who took Premarin or conjugated equine estrogens (CEEs) were more likely to develop blood clots than women who took another kind of treatment, called estradiol.
Although interesting, the findings require further study and randomized trials to confirm their significance.
Another study, sponsored by the National Heart, Lung, and Blood Institute (NHLBI), looked at hormone replacement therapy and its role in preventing chronic diseases, such as coronary artery disease.
Researchers concluded that HRT doesn’t have a valid use in the prevention of chronic disease but that physicians can use it for menopause symptom management on an individual basis.
Balancing risks versus benefits
Some types of hormone replacement therapy can increase the risk of blood clots and stroke. But, the risk is not great for all women, particularly for younger women who are just beginning menopause.
Hormone replacement therapy poses greater risks for any woman who has a history of heart attack, heart disease or stroke, or any woman who has a strong family history of any of these conditions.
No hormone replacement therapy has shown any protective effect against heart disease.
Alternative to drugs
Menopause is not an illness, but rather, a natural process that can cause discomfort for some women.
Lifestyle modifications such as improved diet, healthy weight loss and exercise can help women deal with symptoms without drugs, but for those who find symptoms intolerable, Leslie Cho, MD, Director of the Cleveland Clinic’s Women’s Cardiovascular Center and Section Head of Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, says, “I would say that HRT is a complex issue and that women should speak with their physicians and cardiologist (especially important for our CAD patients) if they are thinking about HRT. There is no ‘one size fits all’.”