Hormone Replacement Therapy Reduces Some Risks for Women and Raises Others

Around the age of 50, some women start to lose control of their emotions, their hormones kick into high gear and then start to disappear, and their reproductive systems start shutting down, signaling the end of the fertile period of their life. For some women this shift can be quite challenging indicated by mood swings, hot flashes, and the emotional repercussions of the loss of fertility when the ovaries stop producing. Although this transition is a natural state in a woman’s life, the rapidly fluctuating hormones can cause an imbalance and leave a woman feeling like she’s on an emotional rollercoaster without an end. When the hormones do eventually stop, women can experience hormone withdrawal symptoms in post-menopause and some are prescribed a treatment to prevent these symptoms by administering an artificial boost of the diminished hormones like estrogen, progesterone, and testosterone in some cases. This treatment is called hormone replacement therapy (HRT) in the United States or just hormone therapy (HT) in Britain.
Lauded as the largest hormone study since the Women’s Health Initiative started recording the results in postmenopausal women in 1991, a new Danish study followed 700,000 postmenopausal women to record their risk of heart problems during the period of HRT use from 1995 to 2001. The Danish study, published in European Heart Journal on October 1, used records of prescription use and heart attacks following otherwise healthy Danish women aged 51 to 69, using estrogen therapy and estrogen therapy with progestin. The results for dangerous risks involved are mixed overall but age and patterns of regular use were able to distinguish higher and lower risks.
The Copenhagen team reports on the validity of their findings of non-U.S. women in a seemingly postmenopausal state aged 51 to 69 even though the risk wasn’t clearly determined in the results, "Of note, our study had no information on menopausal status, although the majority of women in the young age group were postmenopausal due to the cutoff at 51 years." The investigators in Copenhagen continued to stand by their report concluding that it is, “potentially of great clinical importance”.
Lead author Dr. Ellen Løkkegaard, a gynecologist at Copenhagen's Rigshospitalet, believes her findings about other hormone treatments not covered in the U.S. study are valid even though her report overall found no increased heart attack risk among the hormone users. However, she did find that the younger women in the study ages 51 to 54 did show a 25 percent higher risk than the rest of the study’s volunteers. Løkkegaard says that the higher risk may be because the non-hormone users of the volunteer group weren’t completely postmenopausal yet and would naturally incur a lower risk of heart disease.
Before the end of the study however, the findings were potentially positive, with Dr. Løkkegaard praising the conclusion that her team’s main piece of good news to report that taking only estrogen every day and using progestin a few days during the month—which causes monthly vaginal bleeding—is a safer choice for the heart than taking both estrogen and progestin each day, which had 35 percent more risk attached to it. Although finding no real statistics of hormone use being related to the risk of heart attacks, Løkkegaard says, "For women with an intact uterus, cyclic combined therapy (causing menstrual bleedings) should be preferred instead of continuous combined therapy (not causing menstrual bleedings)….And for women without a uterus, dermal application via gel or patch is associated with a lower risk." Although most women in the United States use oral hormone replacement pills, the Danish study suggests that topical gels or patches may reduce the risk as they do not have the same blood-clotting or inflammation effects.
The Rigshopitalet trial in Copenhagen was put on hold in 2001 after almost six years because the data safety board concluded that women subjected to estrogen-progestin treatments had an increased risk of breast cancer, deep vein thrombosis (blood clots), and stroke. It should be noted also that this new study also did not take into account data on smoking habits, exercise routines, or other choices that affect heart attack risk. Only time will tell if these findings hold true and I am sure more trials will be conducted on the potentially harmful effects of hormone gels and patches, but the good news is that there is at least one way to reduce the risk of heart attack on postmenopausal women.