Estrogen offers protection from cardiac disease ; with menopause and lack of estrogen, the risk of cardiac events and stroke rise substantially .Hormone replacement therapy (HRT ) acts differently than natural estrogen.
The biggest controversy about Hormone replacement therapy (HRT ) is whether its risks outweigh its benefits. Over the last 10 years several studies showed that HRT may increase the risk of breast cancer, heart disease, stroke, and blood clots. This data comes from a large study – The Women’s Health Initiative (WHI) , 10 years ago, directing women away from using HRT altogether .
American College of cardiology in 2017 presented new data that the HRT it’s not harmful but maybe beneficial in improving heart health and overall survival in some women, based on age and presence or absence of certain medical conditions.
Where do we stand with HRT in 2019
Who should avoid HRT
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Women of any age ,who have or previously had:
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breast cancer,
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ovarian cancer,
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endometrial cancer,
heart attacks or heart failure
blood clots in the legs or lungs,
stroke
2. Women over 60 or those who want to start HRT more than 10 years from the onset of menopause.
Who should consider HRT
For women with premature menopause the protective benefits of hormone therapy usually outweigh the risk . Menopause before age 45 requires HRT to prevent an increase risk of :
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Osteoporosis
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Heart disease
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Earlier death
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Parkinson’s-like symptoms (parkinsonism)
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Anxiety or depression
Conclusion
HRT are not “all good or all bad” but require risk and benefit assessment based on age and previous medical history of cancer and heart disease
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If HRT is started before the age of 60 or in women with premature menopause ( due to cancer, surgery) , the benefits appear to outweigh the risks.
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However, if your menopause started after age 45 and you don’t have bothersome menopausal symptoms , you do not need HRT to stay healthy. No clear cardiac protection was found in women after age 45.
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Premature menopause ( before age of 45) benefits from HRT .
References
ACC 2017 Hormone Replacement Therapy Associated with Lower Mortality
The Women’s Health Initiative Postmenopausal Hormone Trials: Overview
Melanie
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