It is no secret that February is about the heart. It is the month we celebrate Valentine’s Day and the wellness community brings awareness to cardiovascular health. In the same month, we get to explore our hearts from a physiological and psychological way.
I believe we intuitively know that one experience cannot be separated from the other. I aim to understand just a bit more about the beating muscle in our chest.
Questions like: How is a women’s heart affected around menopause by the decline in estrogen? Can hormone replacement therapy help my female patients prevent heart disease if they are on estrogen?
So, I went looking. I usually research places such as Ebsco, a database for clinicians. I can enter keywords and have access to 1,000 research papers. Part of my job is to decipher what is relevant, and what can impact the life of my patients, my community, and my own health.
The most recent research reaffirms what other papers have proven before, and therefore puts the health question to rest. Hormone replacement therapy can be protective in women against cardiovascular disease. Outcomes are timing-dependent:
- Hormone replacement therapy reduces cardiovascular heart disease and all-cause mortality only when initiated close to the onset of menopause.
- The sweet spot seems to be pointing to the age group of 50–59 years.
- The benefit is that estrogen seems to be protective, lowers your LDL (bad cholesterol) and might increase your HDL (good cholesterol). But not all estrogen is created equal. Read more about the different estrogen types here.
There was a research paper published back in 1996 that suggested that hormone replacement therapy could be linked to higher cardiovascular incidents in women, however, follow-up research has found that the risk seems to be associated with starting hormone replacement therapy 10 years after menopause. These are the checkmarks that I review with my patients to check if they might be a good candidate for hormone replacement therapy.
- History of cancer in yourself, mom, sister, grandmother, or aunt.
- History of Cardiovascular Disease in yourself or other first-degree relatives.
- ability to detox hormones such as estrogen through Functional testing.
- The last time performed a mammogram or a thermogram.
- The last time a pap smear was performed.
In the end, the choice should be determined by you and your clinician. I always counsel my patients to talk about the risk openly, goals and expectations. To take into consideration your own personal history and symptoms that might be relieved by the therapy.
- Zhang G-Q, Chen J-L, Luo Y, Mathur MB, Anagnostis P, Nurmatov U, et al. (2021) Menopausal hormone therapy and women’s health: An umbrella review. PLoS Med 18(8): e1003731. https://doi.org/10.1371/journal. pmed.1003731.
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