Another Reason to Think Twice About HRT

Estrogen is a hormone that is produced mainly in the ovaries; without it we would not be able to have children. During our reproductive years our estrogen level is at its highest; as we age and approach menopause our estrogen level decreases. Also as we approach menopause, our risk of cardiovascular diseases rises -- a risk that continues to increase the older we become. Women who experience natural menopause experience this increase in heart disease risk gradually, while women who experience surgical menopause after hysterectomy with removal of the ovaries experience a sudden increase in their risk of cardiovascular disease (CVD).

Estrogen replacement is most often used to relieve the vasomotor symptoms of menopause such as hot flashes and night sweats, as well as to protect us from the debilitating effects of osteoporosis (bone loss). However, the use of estrogen replacement therapy and its pros and cons have been the subject of much study and debate in recent years.

In July, 2001, the American Heart Association(AHA) added one more group of women who should not use estrogen replacement therapy to the list -- women who are already diagnosed with CVD. According to an article published in the official journal of the AHA, Circulation, there is insufficient information currently available to recommend the use of hormone replacement therapy (HRT) solely for the prevention of primary cardiovascular disease. Neither should HRT be started only for the prevention of secondary CVD. The decision of whether estrogen is started or continued by women should be based only on "established noncoronary benefits and risks, possible coronary benefits and risks, and patient preference."

Other women who need to be particularly cautious about the use of estrogen include women who have:

• Active or chronic liver disease,
  
  
• Previously been diagnosed with breast or uterine cancer,
  
  
• A family history of breast cancer,
  
  
• Active gallbladder disease,
  
  
• A history of blood clots, particularly in the legs or lungs,
  
  
• Severe obesity,
  
  
• Diabetes,
  
  
• Abnormally high blood pressure,
  
  
• Or a history of stroke.

Heart disease continues to be the number one cause of death among American women claiming the life of more than 500,000 women annually. Many of these deaths are preventable by incorporating lifestyle changes recommended by the AHA including not smoking or quitting if you already do smoke, eating a heart-healthy diet, and a program of regular exercise for all women. Women whose lipid and blood pressure levels are abnormal after incorporating these lifestyle changes should be prescribed appropriate medications. According to the AHA, there is "widespread underutilization of established preventive therapies," in women. Health professionals must place more emphasis on preventive interventions.

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