Hormone Replacement Therapy

For 50 million American women, deciding whether to take hormone replacement therapy (HRT) can be difficult and confusing.

Seventeen million women nationwide take HRT, which is proven to reduce menopausal symptoms such as hot flashes and to prevent or limit osteoporosis or bone thinning.

But while there are good reasons to take HRT, protecting your heart is apparently not one of them, according to the American Heart Association, which says there is not enough evidence to uphold the widely held view that HRT protects the heart.

"There's mounting data and evolving science that really questions any benefit of hormone replacement therapy among women who've had a heart attack and stroke," says Dr. Lori Mosca the director of preventive cardiology at New York-Presbyterian Hospital. HRT has been recommended by some doctors for its purported heart-protecting benefits.

Dr. Mosca analyzed data from about 3,000 women with heart disease and the so-called "Hers" study found that those given HRT showed a 52% increase in cardiac events including heart attacks during the first year. After a 4-year follow-up, there was no increased risk compared with patients given a placebo--but no benefit, either.

As a result, the AHA is changing its clinical recommendations.

If a postmenopausal woman has cardiovascular disease and is currently not taking HRT, she should not start therapy unless her doctor recommends it for benefits unrelated to the heart.

Better options for a healthy heart include quitting smoking, exercising, losing weight, and taking drugs to control cholesterol and blood pressure.

The AHA offers additional recommendations:

• If you're currently taking HRT and do not have heart disease, continue your treatment.
• If you are considering taking HRT and do not have heart disease, weigh the benefits and risks by taking the heart question out of the equation.
• Some of the risks of HRT include blood clotting, endometrial cancer, possible breast cancer, and gallbladder disease.
• If you do have heart disease and have been taking HRT for several years, continue if you are taking it for menopausal symptoms or osteoporosis.

"The big question mark is, among women who are otherwise healthy, whether or not HRT would indeed prevent them from future attacks or stroke," Dr. Mosca says. "We don't really know the answer to that question."

The reason for the confusion over healthy women is a lack of large-scale studies. The next one is not due for 5 years.
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