While menopausal hormone therapy increased cardiovascular disease risk in postmenopausal women older than 70 years with vasomotor symptoms, hormone therapy did not significantly affect cardiovascular disease risk in younger postmenopausal women, according to a recent study published in JAMA Internal Medicine.
“These findings provide important support for current clinical recommendations to use menopausal hormone therapy to treat moderate or severe vasomotor symptoms among younger postmenopausal women who do not have contraindications to estrogen use, but to avoid hormone therapy use among women older than 70 years of age,” said Emily Szmuilowicz, MD, associate professor of Medicine in the Division of Endocrinology, Metabolism and Molecular Medicine and a co-author of the study.
Menopause occurs when a patient’s ovaries stop producing reproductive hormones, permanently ending menstruation. Menopause occurs at an average age of 51 years, but age of menopause is variable and can occur sooner due to genetics or medical treatments, such as chemotherapy or surgery.
One of the most common symptoms of menopause is vasomotor symptoms, more commonly known as hot flashes and night sweats. Hormone therapy is currently the most effective treatment for menopausal vasomotor symptoms; however, previous research has raised concerns about the treatment increasing cardiovascular risk in postmenopausal women, according to Szmuilowicz.
“This has led to understandable reluctance among postmenopausal women and their providers to use menopausal hormone therapy. However, the risks of menopausal hormone therapy may vary among postmenopausal women of different ages,” Szmuilowicz said.
In the current study, Szmuilowicz and colleagues conducted a secondary analysis of data from the Women’s Health Initiative, which included two clinical trials and more than 27,000 postmenopausal women ages 50 to 79 years at 40 U.S. clinical centers.
As part of the clinical trials, participants were randomized to receive one of two types of hormone therapy: women with hysterectomy received either conjugated equine estrogens (CEE) or placebo and women with an intact uterus received either CEE plus medroxyprogesterone acetate or placebo. Data were collected from November 1993 to September 2012.
Using this data, the investigators aimed to identify differences in atherosclerotic cardiovascular disease outcomes across different age groups (age 50 to 59 years, 60 to 69 years, and 70 to 79 years).
From their analysis, the investigators found that in younger postmenopausal women (age 50 to 59 years), hormone therapy use did not significantly affect cardiovascular disease risk. In contrast, hormone therapy increased cardiovascular disease risk in women 70 years and older with vasomotor symptoms.
“The findings support guideline recommendations for treatment of vasomotor symptoms with hormone therapy in women aged 50 to 59 years, caution if initiating hormone therapy in women aged 60 to 69 years, and avoidance of hormone therapy in women 70 years and older,” the authors wrote.
The Women’s Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and U.S. Department of Health and Human Services through contracts 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.
