Many women nearing or going through menopause experience difficult symptoms, including hot flashes, night sweats, sexual pain and other issues.

In recognition of American Heart Month in February, Lake Regional Health System is providing education to Lake Sun readers on various heart health topics.

It’s been a touch choice for women: Should they use hormone replacement therapy to treat their menopause symptoms, or should they avoid an effective treatment because it might pose serious health risks, including dangers for their hearts?

“For decades now, women have received conflicting advice about whether hormone replacement therapy is safe for use in menopause,” said Lake Regional Cardiologist Zubair Khan, M.D., FACC. “There is no easy, one-size-fits-all answer. Women need to talk with their doctors to decide whether the benefits outweigh the risks in their situation, and they need to make sure that discussion includes the risk of blood clots, which are a concern with hormone replacement therapy.”

What is hormone replacement therapy?

Many women nearing or going through menopause experience difficult symptoms, including hot flashes, night sweats, sexual pain and other issues that result from female hormone levels going up and down. 

Hormone replacement therapy, also called menopausal hormone therapy, helps steady those hormone levels. There are different kinds of hormone replacement therapy. Some use only estrogen, while others use estrogen and progestin. Most women take daily pills, but skin patches, vaginal creams, gels and rings also can deliver the hormones.  

What are the concerns?

Hormones have impacts throughout the body. Potential risks of hormone replacement therapy include blood clots, breast cancer, endometrial (uterine) cancer, heart attack and stroke. However, the level of risk isn’t the same for all women. Whether a woman’s benefits outweigh her risks depends on several factors, including her age; the severity of her menopause symptoms; the length of her treatment; which hormones she receives and how; and whether she has other health conditions that impact her risk for complications.

As a heart expert, Dr. Khan focuses on how hormone replacement therapy affects women’s risk for heart attacks and blood clots, especially in the lungs and legs.

“Women tend to be more aware of the risks associated with hormone replacement therapy for cancer, especially breast cancer,” Dr. Khan said. “I want to make sure they also ask their doctors about how this treatment might impact their risk for blood clots and heart attacks.”

Currently, research suggests the following about these cardiovascular risks:

Blood clots. Women who have a history of blood clots should not use hormone therapy. For these women, it’s clear that the risks outweigh the benefits. In general, taking hormone replacement therapy may increase women’s risk for blood clots. Women who are obese or smoke while taking hormone replacement therapy have an especially high risk.

Heart attack. Women who have had a heart attack or who have heart disease should not use hormone therapy. For other women, hormone replacement therapy is safest when taken before age 60 or within 10 years of starting menopause. It may increase the risk of developing heart disease in older women and in women who begin using estrogen more than 10 years after their last period.

I’ve talked to my doctor and decided to use HRT. Now what?

“There are two rules I would give women who decide to use hormone replacement therapy: 1) Take the lowest dose that helps, and 2) take it for the shortest time needed,” Dr. Khan said. “Long-term use should be avoided because the risks increase the longer this treatment is used.”

Dr. Khan is a member of a comprehensive heart care team at Lake Regional Health System that includes interventional cardiologists and a cardiovascular-thoracic surgeon, as well as registered nurses and X-ray technologists who specialize in heart care. As a Level II STEMI Center, Lake Regional is equipped to provide timely, definitive heart attack care 24 hours a day, seven days a week. Learn more at