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Menopause, Hormones and Heart Disease: The Battle to Find the Lesser of Three Evils

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

Hot flashes. Night sweats. Sleep disturbances. Mood swings. Irregular and racing hearts. These are all signs of menopause setting in, the time in a woman’s life when her ovaries cease to function signaling the end her fertility years, her menstrual cycle and a drop in naturally produced hormones.

Often aptly referred to as “the change of life,” the period during which some women suffer the many unpleasant symptoms associated with menopause is actually a transitional phase called perimenopause, which can begin from as young as 40 and last until a woman’s early 60s. A woman is considered perimenopausal until one full year after her last menstrual period. After this year has passed, a women can then declare herself as “gone through menopause” and is considered postmenopausal the rest of her life. 

 Hormone-replacement-therapyAs if the possibility of menopausal symptoms setting in as early as age 40 isn’t unsettling enough, check out these disturbing facts: a woman’s risk for heart disease automatically increases at age 40, and heart disease is the leading cause of death in women over 40, particularly those in the midst of menopause. Why? Because the decrease in estrogen caused by menopause has multiple negative effects on the female cardiovascular system including: changes in the walls of arteries and blood vessels which makes plaque and blood clots more likely to form; increased fibrinogen levels which make blood clots more likely to form and narrow the arteries; a decrease in HDL – or “good cholesterol” – and an increase in LDL or “bad cholesterol.”

So what’s a woman to do? It was once thought that hormone replacement therapy (HRT) was the miracle treatment for menopause symptoms, and that is also happened to help keep more serious health threats such as heart disease, cancer and osteoporosis, at bay. Plus, HRT generally helped women feel better, and therefore improve their quality of life. Yet in 2002, the Women’s Health Initiative, a large, national study, found hormone replacement therapy could actually increase the risk of heart disease, stroke and breast cancer. In early July of 2002, the two hormone replacement therapy studies involving estrogen and progestin were halted because the therapy wasn’t showing any preventative benefits against heart disease. Quite the contrary, the women in these studies showed an increased risk of heart attack and stroke, blood clots, breast cancer and even dementia.

So are women to just tough it out during menopause then and simply hope they’re heart healthy? “Treating a woman for menopause depends on many factors, including how severe and life-altering her symptoms are, her current health status, medical and family history and treatment preferences,” said Nazanin Moghbeli, MD, MPH, FACC, the director of the Women’s Cardiovascular Center at Pennsylvania Hospital. “Many symptoms can be effectively managed through lifestyle changes and other types of therapies.” For example, recent research has shown that some women get relief from severe hot flashes with anti-depressant medications and Penn Medicine is currently conducting a new study using a combination of Chinese herbal compounds to treat severe hot flashes and sleep disturbances.

One thing is clear, however. HRT should not be used to prevent heart disease. Nor should women with heart disease take it. And, women need to enlist the help of a physician. They can start with their primary care doctor or their gynecologist and discuss with him or her other ways than HRT to prevent heart attack and stroke, such as lifestyle modifications (i.e. switching to a heart-healthy diet and quitting smoking) and keeping blood pressure and cholesterol levels under control with the proper medications.

Women considering HRT to prevent osteoporosis or relief from menopausal symptoms not being successfully managed by other treatments also really need to talk with their doctors about their possible personal benefits and risks of HRT. “I would also strongly suggest that menopausal women who have a family history of heart disease or are showing symptoms of or have multiple risk factors for cardiovascular disease should seek the professional medical advice of a cardiologist in addition to their primary care physician,” adds Dr. Moghbeli. “A woman’s risk for cardiovascular disease – including heart attack and stroke – bone loss and cancer is subject to change as she gets older. That’s why it’s so important for her see a physician regularly to review her health status.”

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