Menopausal hormone therapy and coronary heart disease: the roller-coaster history

Abstract

In the USA it is estimated that more than one million women become menopausal each year. Coronary heart disease (CHD) is the leading cause of mortality in menopausal woman globally. The majority of perimenopausal to postmenopausal women experience bothersome symptoms including hot flashes, night sweats, mood liability, sleep disturbances, irregular bleeding and sexual dysfunction. While menopausal hormone therapy (HT) effectively treats most of these symptoms, use of HT has become confusing, especially related to CHD risk. Despite years of observational and retrospective studies supporting a CHD benefit and improved survival among HT users, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative (WHI) raised doubts about this long-held premise. The timing hypothesis has since emerged and states that when HT is initiated in younger women, soon after menopause onset, there may be cardiovascular benefit. The following review discusses the roller-coaster history of HT use as it pertains to CHD in postmenopausal women. Studies that highlight HT’s CHD benefit are reviewed and provide reassurance that HT utilized in appropriately selected younger postmenopausal women close to the onset of menopause is safe from a cardiovascular perspective, in line with consensus recommendations.

摘要

据估计, 美国每年有100多万妇女进入更年期。冠心病（CHD）是全球绝经女性死亡的主要原因。大多数围绝经期到绝经后的女性都会出现令人烦恼的症状, 包括潮热、盗汗、情绪不稳定、睡眠障碍、不规则出血和性功能障碍。虽然绝经激素疗法（HT）有效地治疗了大多数这些症状, 但HT的应用已经变得令人困惑, 特别是与CHD风险有关的问题。尽管多年来的观察性和回溯性研究支持HT应用者有益于冠心病和改善存活率, 但心脏和雌激素/孕激素替代研究（HERS）和妇女健康倡议（WHI）对这一长期存在的前提提出了质疑。自那以后出现了时机假说, 该假说指出, 当更年轻的女性在绝经后不久开始实施HT时, 可能会对心血管有益。下面的综述讨论了HT应用的过山车历史, 因为它与绝经后女性的CHD有关。回顾了强调HT对冠心病益处的研究, 并保证适当选择接近绝经初期的年轻绝经后女性应用HT, 从心血管角度来看是安全的, 与共识建议一致。

Keywords:

• Hormone therapy
• menopause
• coronary heart disease
• cardiovascular disease
• timing hypothesis

Acknowledgements

The authors would like to thank Philip Sarrel, MD for critical review and edits of the article.

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.