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HRT, Heart Disease, and Surgical Menopause

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HRT, Heart Disease, and MenopauseAs a younger women who has had an oophorectomy, what do I need to know about HRT and heart disease?

Since the early 2000s, there has been a lot of controversy regarding the relationship between hormone replacement therapy (HRT) and heart disease. Studies about HRT and heart disease have often been conducted with participants in their 50s and 60s, many in natural menopause. Much of the controversy, then, revolves around what these studies mean for younger women who have undergone a bilateral oophorectomy and entered menopause prematurely.

Studies such as the 2002 Women’s Health Initiative (WHI) led physicians and women to avoid HRT, even though the average age of participants in that study was 63 years old. Some follow-up studies are now clarifying the risks and benefits of HRT and differentiating between estrogen only and HRT, and using HRT as part of natural or surgical menopause. These studies are indicating that hysterectomy patients using estrogen only are not at risk for heart disease. In October 2012, the British Medical Journal published a 10-year study looking at the effects of hormone replacement therapy on cardiovascular events in recently postmenopausal women. The results indicated that the risk for various cardiovascular issues was significantly reduced for women who used HRT soon after menopause. Furthermore, the American Journal of Health published a study in 2013 that found that thousands of hysterectomy patients ages 50–59 died prematurely because they heeded the WHI study and did not use estrogen replacement therapy (ERT).

Studies on the risks of bilateral oophorectomy, which results in premature menopause, conclude that there is a higher risk of coronary heart disease and death for women who have their ovaries removed and do not use HRT. According to the American College of Obstetricians and Gynecologists (ACOG), for example, there is a lower prevalence of coronary artery calcium for women who are given ERT immediately after an oophorectomy compared to those who are not given any. This supports WHI findings that women without a uterus who used ERT are less likely to develop heart disease. All these studies suggest that HRT is indeed beneficial for aiding in the heart health of younger women who undergo a bilateral oophorectomy.

Heart disease is the leading cause of death for women after age 40—especially for those in menopause. One of the reasons for the increased risk for heart disease at that stage of life seems to be the decrease in estrogen, though other factors play a role as well. Estrogen is believed to keep blood vessels more flexible, allowing them to accommodate blood flow by relaxing and expanding. It also helps women maintain higher levels of good cholesterol (HDL) and lower levels of bad cholesterol (LDL), decreasing the risk for heart disease. Estrogen also helps the heart by preventing white blood cells from sticking inside blood vessels and causing dangerous blockages. Thus, not having estrogen can create a number or issues, especially for younger women.

Because there are so few studies regarding HRT and heart disease for women facing premature surgical menopause, it is difficult for both physicians and patients to know what may be the best route. In addition, many of the studies done use dissimilar and varying criteria, so it can be hard to compare the results to see how they may apply on a personal level. However, one study* on coronary heart disease and hormone replacement therapy after menopause, concluded that the different studies seem to indicate HRT reduces coronary heart disease for women under age 60 and within 10 years of menopause.

When determining if HRT is right for you, one key question is, “Are you in early surgical menopause, or age-appropriate, natural menopause?” It is also important to consider your personal and family health risks, as there could be factors which affect your ability to use or not use HRT. Because studies are so limited, it is important that you work closely with your medical team to decide what is best for you and your particular situation. If you are feeling uneasy about your options, it might be helpful to seek a second opinion from a knowledgeable doctor.

*conducted by the Atherosclerosis Research Unit, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

03-24-2014 - 06:00 PM


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