Hormones and Your Heart – Who’s Really at Risk?

In 2002 the Women’s Health Initiative (WHI) study published the finding that estrogen did not protect women’s hearts as expected. Not only did it not protect hearts, the results showed that women on hormone therapy actually had more cardiac problems than women who were not taking hormones. In something like a quiet panic, women stopped taking hormones for fear of increasing their risk of heart attacks and stroke.

Now that the alarm has died down, researchers are looking closely at all of the factors that contributed to the conclusion that hormones increased a woman’s risk of heart-related events. One study seems to point the way to a more reasoned approach to measuring the risk of heart disease for women who would like to take hormones for menopausal symptoms.

The study, conducted by the National Heart, Lung and Blood Institute, looked at 271 cases of coronary heart disease that occurred in the first four years of the trials of estrogen, and estrogen with progestin, shows that women who have favorable cholesterol readings (a ratio of “bad” to “good” cholesterol of less than 2.5) were not at more risk of heart disease when they used estrogen, or estrogen with progestin.

But the results were not as hopeful for women who had unhealthy cholesterol readings. For those women, hormone therapy – particularly estrogen alone – seemed to increase the risk of coronary heart disease. Women with higher levels of LDL ("bad") cholesterol should continue to be wary of hormone therapy, since it may make their risk of heart disease even higher than it already is.

More analysis of the WHI data will give us better and better information about our risk for health problems related to hormone therapy. This study offers hope that, at least for women with healthy cholesterol readings, estrogen is still in the running for treating disruptive symptoms during menopause. Check with your doctor if you are having severe menopause-related symptoms. Hormone therapy may not be out of the question after all.

(Illustration: Don Farrall/Getty Images)