NEW! Red Hot Mamas® Menopause Education Program
The Women's Heart Center at Rush-Copley Heart Institute is proud to offer Red Hot Mamas® a nationally recognized menopause management education and psychosocial support program. The goal of Red Hot Mamas® is to empower women to be educated consumers in their healthcare and active participants in the management of their menopause, preparing them for a comfortable menopause and healthy postmenopausal transition.  Learn more>>

Special Focus: Hormone Replacement Therapy & Heart Disease
Coronary artery disease is the single leading cause of death in women. Menopause adversely affects several risk factors for coronary heart disease suggesting that hormones influence the risk of heart disease in postmenopausal women. For instance, Cholesterol and in particular LDL cholesterol increases after menopause. In addition a slight decrease in HDL (good cholesterol) has been seen. Millions of women cross over to post-menopausal age each year. As the life expectancy for women increases, it is expected that women will spend one third of their life in postmenopausal period. Can Hormone Replacement Therapy (HRT) have an impact on preventing or postponing heart disease associated with menopause? The medical community has been trying to answer this question through observational, epidemiological and more recently through well controlled clinical trials.

Several observational and epidemiological studies have shown that women on HRT, in general, enjoy better health and suffer less from heart disease than women who did not take hormones after menopause. As a matter of fact when all of the observational data was combined it showed a possible 30-50% reduction in risk of heart disease. These findings were further strengthened with our knowledge of favorable biological effects that estrogens have on cholesterol levels, and blood vessels. Based on these observations physicians often recommended use of hormones to prevent heart disease and bone fractures.

Recent clinical trials have not supported the observational data, leading to a whole new look at HRT as a strategy for prevention of chronic illnesses. For instance, questions were appropriately raised whether the women in HRT observational studies showed benefits because they paid more attention to their health with regular medical visits, exercise and better eating habits; or due to the fact that they were on HRT? In 1998 data published from the Heart Estrogen/Progestin Replacement Study (HERS) showed that women with preexisting heart disease derived no overall benefit from HRT, in fact the study showed that there was in increase in cardiovascular events in first year of hormone treatment.

The “Women's Health Initiative,” a trial funded by the National Institute of Health, was designed to look at role of HRT in otherwise healthy women. This study included a group of 16,608 women, with intact uterus, who were 50-79 years of age at the start of study. Participants were randomly assigned to receive conjugated equine estrogen and medroxyprogesterone acetate (Prempro), or placebo. After a mean follow up of 5.2 years the study was prematurely terminated as overall risk exceeded the benefits. Specifically, combined HRT was associated with a 24% increase in incidence of cardiac events, and this increase in cardiac risk was evident at end on one year of hormone therapy.

Based on these and other similar trials, it is recommended that HRT should not be prescribed for the sole purpose of preventing heart disease. It is further recommended that if a woman develops heart disease while on hormone replacement therapy, HRT should be discontinued.

Although HRT has shown increased incidence of heart disease in women, hormone therapy is still the most effective way of treating moderate to severe hot flashes associated with menopause. Specifically, over 20% of women suffer from hot flashes at the time of transition to menopause, and HRT relieves these symptoms in up to 80% of women. The most appropriate way of addressing this situation at present is to assess your risk of heart disease, treat these risk factors aggressively and start hormone therapy for relief of hot flashes while closely monitoring your heart health. Specifically, the need for HRT should be reevaluated every 3-6 months in an attempt to reduce the dose and subsequently discontinue hormone therapy. Women with mild symptoms should try alternative methods of getting relief from menopausal symptoms. In addition, cardiovascular health should be monitored and maintained by yourself and your physician through constant attention to risk factor control and early recognition of symptoms.