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- Research presented at the 2024 Annual Meeting of the Menopause Society in Chicago aims to reveal the impact of hormone replacement therapy on various aspects of health.
- One study reports that long-term use of some hormone therapies can improve markers of cardiovascular health during menopause.
- A large meta-analysis further found that hormone therapy can help improve insulin sensitivity by restoring estrogen levels.
It works by restoring the body’s levels of several hormones – usually, but not always, estrogen – as they decline with age, a process that is often responsible for many of the symptoms associated with menopause.
There are plenty of debates about which types of HRT are safe and which are not, and what impact long-term use of HRT could have on health.
A study presented at the meeting, whose findings have yet to appear in a peer-reviewed journal, found that estrogen-based hormone therapy appeared to have a positive long-term effect on almost all markers of cardiovascular health.
The study, led by researchers at Penn State Hershey Medical Center, used data from the Women’s Health Initiative (WHI) and compared cardiovascular health biomarker levels in participants taking certain estrogen-based hormone therapies with a placebo.
The researchers found that those who took conjugated equine estrogens for at least one year saw a 13% increase in high-density lipoprotein cholesterol (HDL-C), also known as “good cholesterol.” Those taking conjugated equine estrogens plus medroxyprogesterone acetate saw a 7% increase in HDL-C levels.
So-called bad cholesterol – low-density lipoprotein cholesterol (LDL-C) – fell by around 11% in both HRT groups. In particular,
For those taking medroxyprogesterone acetate plus, the drop in Lp(a) levels was even greater: 20%.
Finally, the researchers also found that markers of insulin resistance were also lower in those taking HRT: they fell by 14% in participants taking conjugated equine estrogens alone and by 8% in those taking conjugated equine estrogens with medroxyprogesterone acetate.
The only marker of cardiovascular health that did not show improvement with HRT was triglyceride levels.
Due to the various hormonal changes that occur when a person enters menopause, the risk of cardiovascular disease and cardiovascular problems increases.
“Once a woman enters menopause, estrogen levels stop going away, which negatively impacts the cardiovascular system,” says Sheryl A. Ross, MD, a board-certified gynecologist and expert on menopausal health. women at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study presented at the annual meeting, explained Medical news today.
Cheng-Han Chen, MD, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, also not involved in this study, told us that:
“This [drop in estrogen levels] then leads to changes such as increased arterial plaque buildup, increased cholesterol, and increased blood pressure, all of which can increase a person’s risk for heart disease.
That’s because “estrogen production helps maintain the elasticity of blood vessels, lowers LDL or ‘bad’ cholesterol and promotes production of HDL or ‘good’ cholesterol,” Ross further explains.
These mechanisms could explain why long-term estrogen supplementation in the Penn State Hershey Medical Center study led to improvements in biomarkers of cardiovascular health.
“Using estrogen replacement therapy can help by bringing back the benefits of blood vessel elasticity, lowering LDL levels and promoting HDL levels, which support heart health,” Ross also told us.
“It is suggested to begin estrogen replacement therapy as you enter menopause for optimal cardiovascular benefits,” she advised.
Researchers from Reading Hospital Tower Health, Drexel University College of Medicine in Pennsylvania and other institutions presented further findings indicating that HRT was associated with lower insulin resistance in postmenopausal women.
This research team conducted a review and meta-analyses of 17 randomized controlled trials, with a total of 29,287 participants. Of these participants, 15,350 received HRT with estrogen or estrogen plus progestin, and 13,937 received a placebo.
The average age of the participants ranged from 47 to 75 years, and their duration of treatment ranged from 8 weeks to 2 years.
The review and meta-analysis, the results of which which have yet to appear in a peer-reviewed journal, have found that all HRT studies – whether oral or
The improvement in insulin sensitivity associated with HRT is therefore good news, because it could have a protective effect against diabetes.
“Hormone replacement therapy, including estrogen and progesterone medications, […] improves metabolic health by regulating insulin production, maintaining body weight and fat distribution, and reducing the risk of type 2 diabetes,” explains Ross. “These benefits support and improve hormonal balance and metabolic health.”
Even with these positive findings about HRT, doctors warn that some of these therapies may affect different individuals in different ways and may have their own side effects.
G. Thomas Ruiz, MD, a board-certified OB/GYN and chief OB/GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study presented at the annual meeting, said MNT That:
“[Oral] preparations [of] HRT is generally metabolized in the liver and may carry an increased risk
platelet aggregation leading to an increase in clotting in small ones [blood] ships. On the other hand: most [bio]identical hormone replacement therapy is absorbed through the skin, [and thus] avoids being metabolized in the liver and generally has less platelet aggregation effect. [Bio]Identical hormones also have the advantage of being identical to the type of estrogen produced by the ovaries during menstruation.”
Ruiz therefore advised that when looking for the most appropriate HRT, an individual and their doctor may want to consider the type of treatment that resolves the symptoms that concern them most, with the lowest medication dosage.
“For most women, the initial goal is to treat the vasalmotor symptoms associated with menopause. [such as] hot flashes, insomnia, […] joint pain, […] mild depression. Some women will also see changes in their vaginal tissue, which can make sexual activity more uncomfortable due to vaginal dryness,” he said.
“The best hormone replacement therapy is the lowest dose that resolves symptoms,” Ruiz suggested. “Each woman should be treated individually and given what she needs to control symptoms.”
Ross also highlighted that HRT can play a crucial role in reducing the risk of osteoporosis, another problem around the menopause. “HRT, especially in women at risk of osteoporosis, has also been shown to prevent bone loss and fractures,” she told us.
Nevertheless, she warned that:
“Women at increased risk of venous thromboembolism/blood clots, stroke, ischemic heart disease and breast cancer may not be candidates for HRT. Women with a strong family history of breast cancer involving a first-degree relative, mother or sister, especially if they are carriers of the disease
BRCA gene may not be candidates for HRT.”
According to Ross, some questions about the long-term health effects of HRT on menopausal symptoms remain to be answered.
- whether someone should stop taking HRT after the age of 60 to avoid an increase in breast cancer risk, as high estrogen levels have been linked to breast cancer risk
- whether someone should take preventive HRT to support heart health even if he or she does not have disruptive symptoms of menopause
- whether they should take HRT for brain health, to lower their risk of dementia
- and whether they can safely use pellet or compound HRT if they have disruptive menopausal symptoms.
From his perspective, Chen also noted that doctors “remain concerned that long-term HRT treatment may increase an individual’s risk for blood clots, stroke and breast cancer.”
Ross said the most important thing for now is to seek specialist medical advice that takes into account the person’s individual situation.
“Discuss any questions or concerns you have about HRT with your healthcare provider […]so you can make the best decision for your personal health,” she emphasized.
