For a long period, application of Hormone Replacement Therapy (HRT) among the medical fraternity was thought a breakthrough solution to reduce the likelihood of reducing cardiovascular-related diseases in postmenopausal women. Surprisingly, recent research reveals converse results where HRT might not help reduce the risk of heart disease in postmenopausal women and might even increase it (Scholten, 2011). Empirically, the application of Hormone Replacement Therapy emerged from the need to mitigate the rising deaths reported amongst women with severe postmenopausal symptoms owing to a huge drop in hormonal levels, causing heart-related diseases. However, the observations reveal that women experiencing postmenopausal symptoms such as cardiovascular complications fail to benefit, and that they are exposed to more harm while under HRT.
Previously application of HRT as a breakthrough was grounded on the fallacy that it reduces the prevalence of cardiovascular diseases by inducing cardioprotective mechanism against declining levels of estrogen during postmenopausal period. The atheroprotective role of Hormone Replacement Therapy was supported by various assumptions surrounding the adjustments of the body to decreased levels of hormones in attaining menopause. Firstly, conducting selective screening will positively predict potential complications in the use of HRT amongst women with an incidence of venous thromboembolism. Moreover, assessment of risk-benefit ratio in postmenopausal women through predictive factors to identify high-risk women would easily ascertain those with genetic predisposition of prothrombotic mutations. Notably, the prime assumption of the study was the frequency of using the postmenopausal hormone amongst patients with ACS and how usage varied regionally remained less unknown. Conversely, using HRT in acute settings was perceived to reduce the severity of stroke while its use in surviving individuals of ST segment was associated with increased ischemic events in follow-up (Parsons, Bhapkar, Alexande, & White, 2004).
As revealed in the Heart and Estrogen/Progestin Replacement Study (HERS), secondary prevention of postmenopausal symptoms using Hormone Replacement Therapy leads to increased incidence of cardiovascular events in women with stable coronary diseases (Parsons, Bhapkar, Alexande, & White, 2004).However, the degree of the clinical outcomes varies with time of initiating HRT administration in postmenopausal women. For instance, using estrogen therapy from the onset of menopause is initially cardioprotective as the endothelium responds to create a buffer to coagulation, but declines following endothelial damaging in late postmenopausal stage leading to increased cardiovascular risk. In agreement, cardiologists and gynecologists uphold the observation by stating that the administration of HRT is inappropriate for older postmenopausal women, displaying no menopausal symptoms (Botto, Maffei, Manfredi, Colombo, Mazzone, & Andreassi, 2011).
On the other hand, individual susceptibility arising through the presence of factor V Leiden or PT G20210A mutation predisposes the women to thrombotic complications, obscuring the benefit of using Hormone Replacement Therapy (Botto, Maffei, Manfredi, Colombo, Mazzone, & Andreassi, 2011). This demonstrates the increased risk of using HRT in women with inherited thrombotic factors such as MTHFR gene, heightening the chance of contracting venous thrombosis. In addition, the association of HRT usage with myocardial infarction heightens when the prothrombin G20210A variant is present in the individual, putting the use of Hormone therapy at questionable levels. In practice, indiscriminate genetic screening may solve the issue though lack of cost effectiveness and psychological problem are barriers to its acceptability. Lastly, Receiving the HRT generates increasing potential risk factor for heart diseases and stroke in older women, the vasculature of each individual determines the degree of susceptibility. In particular, older women with a healthy vasculature generate a protective effect, no effects for those with a mild to moderately unhealthy vasculature and a damaging effect for those with an unhealthy one (Tolle, Nunn, Maynar, & Maynar, 2008).
On the other hand, despite the raised concerns of risk of receiving Hormone Replacement Therapy and the likelihood of increasing cardiac events, it has perceived benefits. Firstly, the HRA meta- analysis indicates that taking HRT reduces the chances of suffering bone fractures and thus combat osteoporosis associated with deterioration of bone mass (Tolle, Nunn, Maynar, & Maynar, 2008). Aging women after menopause often register huge drops of calcium level often protected by estrogen. Subsequently, after menopause this protection gradually declines in aging women resulting in osteopenia. Taking HRT reduces the incidence of bone fracture for women by reversing the bone mineral density loss often associated with thinning of the bones such as wrist, spine and hip (National Health and Medical Research Council, 2005). Furthermore, reducing intake of Hormone Replacement Therapy wanes the protection returning the risk of suffering fractured to the circumstances similar to the absence of estrogen.
Additionally, while receiving HRT increases the risk of suffering various types of cancers including breast cancer, endometrial cancer and ovarian cancer, the MHRA meta-analysis reveals a declining risk of suffering colorectal cancer, which reverses when HRT treatment ceases. Nevertheless, prescription of Hormone Replacement Therapy should be avoided among individuals with established cardiac events, and the long-term benefits in preventing osteoporosis should be weighed against the risks of cardiovascular disease and breast cancer (Scholten, 2011).
In conclusion, despite the varying benefits/risk ratio amongst individuals using HRT amongst women suffering severe menopause complications, the effect it has in increasing cardiovascular diseases, blood clots, ovarian and breast cancers is immense and may seemingly outweigh the benefit of reducing bowel cancer and osteoporosis. Consequently, active discussion with patients on the prevalence of the symptoms and the history of their cardiovascular disease would minimize the victims of adverse HRT reactions. Alternatively, genetic screening on accounts of past incidences of cardiac attacks would avoid denying benefits of Hormone Replacement Therapy to women of unreported adverse reactions.
- Botto, N., Maffei, S., Manfredi, S., Colombo, M. G., Mazzone, A. M., & Andreassi, M. G. (2011). Prothrombotic Mutations, Family History and the Risk of Thrombosis in Postmenopausal Women: Implications for Hormone Replacement Therapy. Climacteric, 14, 25-30.
- National Health and Medical Research Council. (2005, March). Hormone Replacement Therapy: Exploring the Options for Women. Retrieved July 12, 2013, from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh36.pdf
- Parsons, E., Bhapkar, K. N., Alexande, K. P., & White, h. D. (2004). Postmenopausal Hormone Use in Women with Acute Coronary Sydromes. Journal of Women’s Health, 13, 863-872.
- Scholten, A. (2011). Hormone Replacement Therapy (HRT): Does It Reduce Heart Disease Risk in Postmenopausal Women? Retrieved July 12, 2013, from http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=31414
- Tolle, R., Nunn, P., Maynar, T., & Maynar, T. (2008). An Overview of the Risks of Hormone Replacement Therapy. Retrieved July 12, 2013, from http://www.lloyds.com/~/media/lloyds/reports/emerging%20risk%20reports/emerging%20risk%20report%20thumbs/hrt_overview_of_risks.pdf
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