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Does HRT protect us from heart disease?

At the moment I’m not taking HRT. But, as someone interested in the menopausal journey I’m really interested in it. I’m aware of many doctors that are experts in the field that are really promoting HRT as a way of protecting our long term heart health and using it from early perimenopause to prevent heart disease.

And I’ve asked myself many times ‘Am I being foolish not to?’

I recently read an interview with Kathryn Lindley, an MD and clinical investigator in the Division of Cardiovascular Medicine at Vanderbilt University Medical Center and it’s valuable info that we should all know.
Its a bit to long to put here on insta but please check my blog on the garbohouse web site if you’re interested.

Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? – cited 96 papers, articles and studies. The authors included gynecologists, women’s health internists, endocrinologists, as well as Stephanie Faubion, medical director for the North American Menopause Society, all members of the American College of Cardiology Cardiolovascular Disease in Women Committee.

While the review agreed with the idea that HRT could prevent heart disease the data doesn’t hold up. In fact, taking HRT can actually increase cardiovascular events.

The increased risk is very low, so, if you’re taking HRT and it’s helping with your menopausal symptoms then, no worries, carry on. But there’s no need or benefit to taking it as a preventative measure.
If you are at increased risk with heart issues then it’s important that you weigh up the risk/benefits as you would with any medication.

In interview she said: “So, you know, when hormone replacement therapy first came out, the thought was that it was actually going to be really beneficial for reducing cardiovascular events in women. And really the theory behind that made a lot of sense. We know that hormone replacement therapy does have positive effects on cholesterol and weight, and we know that women really do seem to be protected against cardiovascular disease until they go through menopause. Therefore, it seems like it would make sense that if you gave patients hormone replacement therapy, it would delay or prevent cardiovascular disease. And so it was just being used like crazy to help prevent cardiovascular disease. Fortunately, there have been several very large, well-conducted studies that have shown that that is not the case.

“There is actually an increased risk of cardiovascular events among patients who are taking hormone replacement therapy. And so really the way we need to think about approaching hormone replacement therapy is not using it to prevent long-term cardiovascular events, but thinking about what is that risk-benefit ratio for the symptomatic patient who really could have improvement in their quality of life by taking hormone replacement therapy, and how do we weigh that against the potential risk of cardiovascular events, which is different, depending on who your patient is.”

Later in the interview she said: “Really, if you’re gonna start it, you need to start it early. We still recommend using the lowest effective dose and tapering it off as soon as your symptoms begin to resolve.”

This feels really important to know as there’s a lot of advice which suggests take HRT long term. In my work I hear a lot of women’s stories and experiences with taking hormones, whether it’s the contraceptive pill (often used for menstrual issues and not even for contraception), the morning after pill, coils, patches or HRT and often times women’s experiences aren’t great. I think we need to be very careful when putting hormones in our bodies and to really make sure it’s the best choice for us.

It seems to me that in the uk there’s not enough expertise in our doctors and a bit of a one size fits all approach which doesn’t serve us as individuals with unique needs.

The paper was published in the American Heart Association’ journal Circulation in Feb ’23 and the interview was from hotflash inc.