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Morton Rinder, MD, FACC, St. Luke's Hospital

A close look at hormone replacement therapy

Hormone replacement therapy (HRT) remains a hot topic for women and their doctors. In the 80s and 90s, the goal of HRT was to reduce heart disease in women by targeting estrogen withdrawal after menopause. Medical experts recognized women developed a significant risk for heart disease after menopause as their ovaries stopped producing estrogen and their blood vessels went through various changes. This risk accelerates to the point that women who are postmenopausal have a heart disease risk similar to men ages 60 or 65.

Oral estrogens were used by women in the 70s and 80s to help reduce menopause symptoms. Most women reported an improvement in night sweats and mood swings. The Nurses' Health Study, one of the largest and longest-running investigations of factors influencing women's health, sent questionnaires to nurses who took hormones to determine if those nurses had fewer health issues than those who did not. The study showed a significant reduction in heart disease and stroke among hormone users. As a result, investigators embarked on even larger studies.

These expanded studies included all women 50 to 75 years old and showed no overall health benefit of taking medication. Moreover, the studies showed an increased risk of breast cancer and slightly increased risk for stroke. When the results were broken down, it was clear that patients who had heart disease, were older or had other risk factors for heart disease had a higher risk of a cardiac event, while those who were young and healthy had a very low risk and even some protection.

The recent studies have caused caution with doctors considering estrogen therapy for all patients. It's clear that hormones are not safe in some women but are safe and effective in others. HRT should be avoided in patients who have many risk factors for heart disease, stroke or cancer. Finally, there is mounting evidence from European trials that hormones applied by patch to the skin may have more beneficial effects than oral therapy.

If you are considering HRT for menopausal symptoms, consult your physician - especially if you have risk factors for heart disease, stroke or cancer.

Dr. Morton Rinder specializes in internal medicine, general cardiology and interventional cardiology at Premier Heart Group, located on St. Luke's Hospital's campus. Call 314-485-3500 or visit his Physician Referral page.

This article was published in the St. Louis Post-Dispatch on October 22, 2009.