How does hormone therapy affect heart and metabolic health? Image credit: Santi Nuñez/Stocksy. The study, presented at the 2024 Menopause Society Annual Meeting in Chicago, aims to determine the impact of hormone replacement therapy on various aspects of health. One study reported that long-term use of some hormone therapies may improve markers. A large meta-analysis further found that hormone therapy helps improve insulin sensitivity by restoring estrogen levels.
It works by restoring the levels of various hormones (usually, but not always estrogen) in the body. These hormones tend to decline with age, and this process is often the cause of many of the symptoms associated with menopause.
There is much debate about which types of HRT are safe and which are not, and how long-term use of HRT may affect your health.
A study presented at the conference found that estrogen-based hormone therapy had long-term positive effects on nearly all markers of cardiovascular health, although the findings have not yet been published in a peer-reviewed journal. It turns out that it is.
The study, led by researchers at Penn State Hershey Medical Center, used data from the Women’s Health Initiative (WHI) and compared participants receiving certain estrogen-based hormone therapies with those taking a placebo. Participants’ cardiovascular health biomarker levels were compared.
Researchers found that subjects who took conjugated equine estrogen for at least a year had a 13% increase in high-density lipoprotein cholesterol (HDL-C), also known as “good cholesterol.” HDL-C measurements increased by 7% in the conjugated equine estrogen plus medroxyprogesterone acetate group.
The so-called bad cholesterol, low-density lipoprotein cholesterol (LDL-C), was reduced by about 11% in both HRT groups. In particular, lipoprotein(a) or Lp(a), a type of LDL-C that is strongly associated with various cardiovascular diseases, was reduced by 15% in the group receiving conjugated equine estrogen alone.
In patients taking medroxyprogesterone acetate, the reduction in Lp(a) levels was even greater, by 20%.
Finally, the researchers found that markers of insulin resistance were also lower in participants receiving HRT, with a 14% decrease in participants taking conjugated equine estrogen alone, and 14% less in participants taking medroxyprogesterone acetate and conjugated equine estrogen. They also found an 8% decrease in participants who did.
The only cardiovascular health marker that did not show improvement with HRT was triglyceride levels.
Research has shown that entering menopause causes a variety of hormonal changes that increase your risk of heart disease and cardiovascular disease.
“When a woman goes through menopause, her estrogen levels are no longer present, which negatively impacts her cardiovascular system,” says Physician, a board-certified obstetrician-gynecologist and director of women’s health at Providence St. John’s Health Center in Santa Monica, California. Expert Dr. Cheryl A. Ross told Medical News Today that she was not involved in the research presented at the annual meeting.
“We’ve seen a lot of research,” said Chen-Han Chen, M.D., a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., who was also not involved in the study. Ta.
“This (lower estrogen levels) can lead to changes such as increased build-up of arterial plaque, increased cholesterol, and increased blood pressure, all of which can increase the risk of heart disease.”
That’s because “oestrogen production helps maintain blood vessel elasticity, reduces LDL or ‘bad’ cholesterol, and promotes production of HDL or ‘good’ cholesterol,” Ross further elaborated. .
These mechanisms may explain why long-term estrogen supplementation in the Penn State Hershey Medical Center study led to improvements in biomarkers of cardiovascular health.
“Estrogen replacement therapy is beneficial because it restores the elasticity benefits of blood vessels, lowers LDL levels, and promotes HDL levels, which support heart health,” added Dr. Ross.
“For optimal cardiovascular benefits, we recommend starting estrogen replacement therapy once you reach menopause,” she advised.
Researchers from Reading Hospital Tower Health, Drexel University School of Medicine in Pennsylvania, and other institutions have published additional findings suggesting that HRT is associated with reduced insulin resistance in postmenopausal women.
The research team conducted a review and meta-analysis of 17 randomized controlled trials involving a total of 29,287 participants. Of these participants, 15,350 were receiving either estrogen or estrogen and progestogen HRT, and 13,937 were receiving a placebo.
The average age of participants ranged from 47 to 75 years, and treatment duration ranged from 8 weeks to 2 years.
Although the results of this review and meta-analysis have not yet been published in a peer-reviewed journal, all HRT studies, whether administered orally or transdermally, were found to be associated with improved insulin sensitivity after menopause. .
Therefore, improving insulin sensitivity with HRT is good news as it may have a protective effect against diabetes.
“Hormone replacement therapy, which includes estrogen and progesterone medication, (…) improves metabolic health by regulating insulin production, maintaining weight and fat distribution, and reducing the risk of type 2 diabetes. ” Ross explained. “These benefits support and improve hormonal balance and metabolic health.”
Despite these positive results regarding HRT, doctors caution that some of these treatments may affect different individuals in different ways and may come with unique side effects. I’m doing it.
G. Thomas Lewis, M.D., a board-certified obstetrician-gynecologist and chief obstetrician-gynecologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, who was not involved in the study presented at the annual meeting. He told MNT:
“(Oral) formulations of HRT tend to be metabolized in the liver, which can increase the risk of increasing platelet aggregation, which increases clotting within small (blood) vessels. (Biologically) identical hormone replacement therapy is absorbed through the skin, (therefore) avoids metabolism in the liver, and (biologically) identical hormones tend to have less platelet aggregation effects during the menstrual period. It also has the benefit of being identical to the type of estrogen produced by the ovaries.
Therefore, Ruiz advised that when looking for the most appropriate HRT, individuals and their doctors may need to consider the type of treatment that addresses the symptoms of most concern with the lowest dosage. .
“For most women, the initial goal is to treat the vasomotor symptoms associated with menopause, such as hot flashes, insomnia, joint pain, and mild depression. , vaginal dryness can make sex more uncomfortable,” he said.
“The best hormone replacement therapy is the lowest dose that resolves the symptoms,” Lewis suggested. “Each woman should be treated individually and given what she needs to manage her symptoms.”
Professor Ross also highlighted that HRT may play an important role in reducing the risk of osteoporosis, another menopausal concern. “HRT has also been shown to prevent bone loss and fractures, especially for women who are at risk for osteoporosis,” she told us.
Nevertheless, she warned:
“Women at high risk for venous thromboembolism and blood clots, stroke, ischemic heart disease, and breast cancer may not be candidates for HRT. Women with a strong family history of breast cancer in a first-degree relative, mother or sister. Women who have the BRCA gene may not be candidates for HRT.
Ross says there are still some unanswered questions about the long-term health effects of HRT for menopause.
High estrogen levels are associated with breast cancer risk, so whether you should stop HRT after age 60 to avoid increased risk of breast cancer Supports heart health even if you don’t have devastating menopause symptoms Whether you should take HRT prophylactically for your brain health, to lower your risk of dementia, and if you have disruptive menopausal symptoms. , consider whether pelleted HRT or combined HRT can be used safely.
From Chen’s perspective, doctors also “remain concerned that long-term HRT treatment may increase the risk of blood clots, stroke, and breast cancer.”
Dr Ross said the most important thing for now is to get professional medical advice that takes into account a person’s individual circumstances.
“If you have any questions or concerns about HRT, please discuss them with your healthcare provider (…) so you can make the best decision for your health,” she stressed.
