Contrary to what many people believe, cardiovascular diseases (CVD) affect women as much as, if not more than, they affect men. Despite advances in its prevention, diagnosis, and treatment, cardiovascular disease remains the leading cause of death worldwide. One of five women in the US die of heart disease, especially as the risk of CVD increases in the years after menopause. Since menopause and estrogen loss are linked to a spike in cholesterol levels, some researchers have considered hormone replacement therapy (HRT) as a possible solution to the problem.
So can hormone replacement therapy (HRT) really minimize the risk of cardiovascular diseases (CVDs) in a menopausal woman? Hormone replacement therapy is recommended for menopausal women to reduce their risk for CVD. Based on the current understanding that the drop in post-menopausal estrogen levels leads to a buildup of fat and cholesterol in the arteries, the likelihood of CVDs developing can be minimized by correcting hormonal imbalances through HRT.
Hormone replacement therapy, which is also known as hormone therapy (HT) or menopausal hormone therapy (MHT) is a treatment initially designed to help women alleviate hot flashes, sweating, bone thinning, vaginal dryness, and other signs of menopause. While there are different methods of hormone delivery available, the overall goal is the same: balance oestrogen and progesterone levels during or near menopause.
With HRT medication, patients can recover the hormones their body has stopped producing due to menopause. Estrogen, in particular, is a hormone that protects women against heart disease; it is known to combat rising lipid (fat) levels, narrowing blood vessel walls, and increasing fibrinogen production which causes blood clots. Aside from fighting CVDs, HT can also reduce the possibility of developing debilitating diseases like osteoporosis and colorectal cancer as well.
Hormone replacement is especially encouraged for patients who are experiencing early menopause, unless there is a specific reason from them not to take it. HRT should not be taken as a form of disease prevention, as doing so could disrupt your hormone levels.
Before going in-depth on cardiovascular diseases and hormone therapies, it’s important to take a look at what menopause is and how it affects women’s bodies.
Menopause is a natural event that marks the end of menstruation in a woman’s life. Much like how the first menstrual period is the beginning of puberty, menopause is the ‘last period’ that signals the end of her reproductive years between the ages of 45 - 55.
As a woman approaches her late 30s, her ovaries gradually begin to produce less estrogen and progesterone hormones. When the ovaries stop producing oestrogen, the female sex hormone, changes occur to the menstrual cycle. The woman stops ovulating or releasing a mature egg monthly. Menopause is officially confirmed once a woman has stopped having her period for 6 - 12 consecutive months.
Sometimes, menopause and estrogen decline also occur under other circumstances. Carcinoma therapies, premature menopause, and surgical removal of the ovaries may all induce menopause as well:
Aside from regulating the menstrual cycle, oestrogen also has an effect on almost every tissue in the body and its decreased levels manifest physically. Many women, although not all, would experience uncomfortable signs before, during, and after menopause such as:
Most of these symptoms can be managed through lifestyle changes and hormone replacement therapy.
Menopause actually arrives in phases, typically referred to as perimenopause, menopause, and postmenopause. Each stage of menopause marks a gradual transition in a woman’s life and their overall health. Physical signs could also be vastly different when comparing the early stages to the latter ones.
Menopause leads to drastic changes in the balance of your hormones, which are the chemicals produced by the body and released into the bloodstream. Each hormone plays a critical role in ensuring you maintain your bodily functions; they regulate processes like appetite, metabolism, body temperature, sleep cycles, reproductive cycles, sexual function, and mood. Even a slight change would have a noticeable effect on your overall health and wellbeing.
Although hormone levels naturally fluctuate during various life stages like puberty, menopause in women completely alters the chemistry and rhythms of their body for the rest of their life. A hormonal imbalance occurs because there is too much or too little of certain hormones. Here is a look at the three major hormones involved in menopause:
|What is its role?
|What are the effects of menopause on its production?
|How does it affect the body?
|As the primary female hormone, oestrogen promotes the health and growth of female reproductive organs. It stimulates growth of breast tissues, protects bone quality and keeps the vagina lubricated, elastic, and supplied with blood.
|During perimenopause, estrogen levels fluctuate and become unpredictable. Eventually, it falls and maintains a low level during and after menopause.
|Estrogen decline causes a number of complaints, such as vaginal dryness, night sweats, insomnia, headaches and more. Almost all menopausal symptoms are linked to lower estrogen levels.
|Progesterone is another female hormone produced by the ovaries. It’s responsible for preparing the uterus lining for a fertilized egg.
|Progesterone decreases in perimenopause until the body stops producing it altogether after the final menstrual period.
|Fluctuating progesterone levels affects menstrual periods. This is why menstrual cycles prior to menopause become longer, heavier, or more irregular.
|Testosterone is a male androgen hormone, produced by the ovaries and adrenal glands at lower levels in women. It plays a key role in estrogen production and maintains the body’s muscle and bone mass.
|For women, testosterone production peaks in their 20s and slowly declines with age. By menopause, testosterone levels are at half of their peak. The ovaries continue to produce it even after estrogen and progesterone drops.
|Some patients complain about muscle weakness due to testosterone decline. Researchers also suggest low testosterone levels may dampen female libido or sex drive, but that continues to be up for debate.
Menopausal and postmenopausal tend to experience hormonal imbalances which increase their risk of chronic medical conditions. When estrogen supply dwindles, postmenopausal women are more likely to have osteoporosis, urinary incontinence, colorectal carcinomas, and unhealthy weight gain.
Although scientists are still learning about how estrogen fluctuation affects the body, it’s clear that estrogen is active in every tissue and organ system. This includes the heart and blood vessels, where estrogen can:
Traditionally, estrogen has been defined as the protector of the heart. When estrogen levels drop, doctors observe a jump in heart disease risk as LDL cholesterol increases and HDL cholesterol decreases. This leads to a buildup of fat and cholesterol in the arteries, which develop as heart or circulatory system disorders like heart attack (myocardial infarction), stroke, high blood pressure, high cholesterol, and high triglyceride levels. Poor vasomotor symptoms also include changes in blood pressure, night sweat, hot flushes, and heart palpitations.
From this point-of-view, it makes sense to replace estrogen through hormone replacement therapy. Doctors prescribed HRT to a number of women in order to improve their heart health and keep the inner linings of their blood vessels flexible. However, recent studies on the long-term use of HRT are challenging the traditional way of thinking.
After large-scale trials were conducted, researchers discovered mixed results: the risk for heart attack, stroke, and breast carcinoma increases the longer HRT is used. According to the largest randomized, controlled trial to date, there is a small increase in heart disease for postmenopausal women using combined estrogen and progestin hormone therapy. On the other hand, some clinical studies also suggest that oestrogen replacement alone won’t increase the risk of heart disease, but may not provide the protective benefit against coronary heart disease.
As study outcomes are affected by a number of factors, it’s hard to determine what exactly is the most accurate finding. The current recommendations from the CDC are as follows:
If you’re suffering from menopausal or postmenopausal symptoms but are worried about the negative side effects of hormone replacement therapy, you should consider:
Risk factors are conditions or lifestyle factors which make a person more likely to develop a certain disease or increase the chances that an existing condition will get worse. When it comes to CVDs, most doctors look at the risk factors that can be managed as some risk factors, like age and family medical history, cannot be changed. However, they do make your physicians aware of what you could be at risk for. Coronary heart disease risk factors for women include:
Menopausal and post menopausal women face a lot of potential risks and medical complications as they age. Fortunately, hormone replacement therapies can address some of the complaints of menopause and manage certain risk factors as well, especially for women who experienced menopause too early.
Hormone replacement therapy is medication that contains female hormones, usually taken to replace estrogen that the body has stopped producing during menopause. Hormone therapy is most often used to treat common menopausal symptoms, but is sometimes utilized to minimize bone loss and reduce fractures in postmenopausal patients as well.
Although there are some risks associated with estrogen replacement therapy, it largely depends on the type of hormone therapy administered, the dosage prescribed, how long the medication was taken, and personal health risks of the patient. In order to achieve the best results, hormone replacement therapies should be tailored to the specific patient and reevaluated frequently to see if the benefits continue to outweigh the risks.
Currently, there is still a debate on whether hormone replacement therapies can provide cardiovascular benefits. There are a number of studies investigating the long-term effects of hormone therapy on postmenopausal women who receive it closer to menopause versus later in life. Based on existing research, HRT is recommended only as a tool for managing physical manifestations of menopause rather than a preventative solution, and should only be administered under close medical supervision.
There are also a number of risks depending on your current age and stage of menopause, hormone dosage, the type of hormones you take, the method of delivery, and whether or not you’re taking unopposed estrogen or estrogen combined with progestin (the synthetic form of progesterone). Other factors like family medical history and cancer risk should be taken into account as well.
If you’re relatively healthy, you may want to consider the benefits of HRT:
Patients are often confused or afraid when they hear about hormone therapy because they don’t really know what to expect. Here are a few common questions women ask prior to undergoing HRT:
Q: Are hormone replacement therapies safe?
A: Yes, as long as you take the appropriate amount of medication that’s right for you. There are different types of menopausal and postmenopausal hormone therapy, delivered in various ways. Even the length of time it takes for symptom relief varies from person to person, so be sure to visit a provider who can customize the procedure for you.
Q: What are the different types of products?
A: Estrogen and progestin are available in a number of forms. If your uterus hasn’t been removed, most providers prescribe progestin to balance the effects of estrogen in the uterus. There are two major kinds of hormone therapies which can replace what you lose after menopause:
Q: How long will it take for the body to adjust to the new hormones?
A: Side-effects usually improve over time, so talk to your doctor if they are still severe and persist after three months. It’s also good to check back with your provider after six months to see if the hormones are making a difference, if there should be changes to the dose, and if the side effects are still “normal”. Some doctors prescribe cyclical HRT with estrogen and progestin to align with the normal menstrual cycle, so the body is more receptive to the new flow of hormones.
Q: How long until results can be felt?
A: Results tend to differ from person to person. Depending on the dosage and hormone type (estrogen, progestin, or combined), most patients observe changes within the first few weeks or months after treatment. For bioidentical progestin or estrogen, results can be experienced in as little as two weeks because bioidentical hormones are formulated to mimic the body’s natural hormones. This allows for a quicker adjustment period.
Hormone replacement therapies are not for everyone. The basic rule of thumb doctors follow before prescribing HRT is whether or not the benefits of hormone therapy outweigh the risks. Even though hormone therapy can treat menopausal symptoms and reduce the risk of some debilitating diseases, it also has the potential to increase the risk of other diseases -- albeit minimally. These small risks and side effects must be balanced against the actual benefits of HRT for each individual patient.
Hormone replacement therapies are not recommended for patients who have had a myocardial infarction, heart diseases, or history with blood clots. Some common side effects of oestrogen or progestin therapies include:
HRT has also been studied to increase the likelihood of developing breast cancer, endometrial carcinoma, venous thromboembolism, and cholecystitis.
As mentioned earlier, a healthy lifestyle should not be underestimated for its role in preventing heart disease among menopausal and postmenopausal women. Take cardiovascular risk seriously by following these do’s and don’ts to reduce the risk of cardiovascular disease during and after menopause:
1) Do quit smoking.
Smokers are at a much higher risk for heart disease compared to nonsmokers. Preserve your cardiovascular health by saying goodbye to your cigarettes and staying away from secondhand smoke as much as possible. Ask your physician for tips on how to best break your smoking habit.
2) Don’t exceed your recommended body weight.
Growing overweight leads to an early onset of heart disease. When you go over your ideal weight, your heart has to work harder to pump blood and replenish nutrients throughout your body. A healthy diet, regular exercise, and sufficient sleep are the most effective methods of weight loss available.
3) Do exercise weekly.
Your heart is just like any other muscle: it needs to undergo regular workouts to keep it strong and healthy. Being active and exercising regularly -- at least 150 minutes per week -- improves the ability of your heart to pump blood and reduces stress. Be sure to incorporate aerobic exercises for additional cardiovascular conditioning.
4) Don’t eat and drink junk.
While it is tempting to open up a bag of chips or drink a few cans of beer to unwind after each long, stressful day, it’s best to eat junk food occasionally and in moderation. Your diet is a major lifestyle factor that affects everything else in your body, so your cardiovascular health will definitely benefit from a high-quality diet that’s low in saturated fat and trans fat.
A diet that is high in fiber, whole grains, nuts and legumes, fruits, vegetables, fish, soy products, and folate-rich foods can reduce blood pressure, lower cholesterol, and maintain healthy weight. It’s best to avoid sweets, red meat, fatty and processed foods as well. As for drinks, you can indulge in 1 - 2 alcoholic beverages per day to keep the heart healthy, but no more than that.
5) Do treat, manage, and control your medical conditions.
Diabetes, high cholesterol, and high blood pressure are all known risk factors for heart disease. Have regular checkups and health screenings so you can detect and treat these conditions as early as possible. Some doctors recommend:
6) Don’t stress out.
Psychosocial and mental stress are associated with an increased risk of heart problems. Menopausal and postmenopausal women are also more prone to suffer from depression, which is linked to a doubled risk of stroke among middle-aged women. While the transition from perimenopause to menopausal and postmenopausal stages can be an emotionally difficult time, it’s important to stay positive and stress-free. Practicing good habits and engaging in socialization can greatly improve mood and relieve stress in older women.
At Revitalize You MD, we aim to provide the best care for you and your health. Aside from bioidentical hormone replacement therapy, we also offer a number of medical and aesthetic procedures which can be tailored to suit your personal needs and goals. You don’t have to suffer through discomfort and low self-esteem; bring back wellness to your body with help from our certified and licensed medical staff. Schedule an appointment with Revitalize You MD today.
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