Hormone replacement therapy during menopause may not reduce the risk

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Researchers say some menopause treatments are not very effective at reducing the risk of certain diseases. SolStock/Getty Images
  • In a new study, researchers say they can no longer support the use of hormone replacement therapy as a preventive measure for cardiovascular disease. However, they say it may help reduce vasomotor symptoms such as hot flashes.
  • They also said they can no longer support calcium and vitamin D supplementation, which are sometimes used to prevent fractures, as preventative therapy.
  • The researchers did say that low-fat diets could help reduce the risk of breast cancer mortality in the long term.

Hormone replacement therapy to prevent cardiovascular disease, a low-fat diet to prevent breast or colorectal cancer, and calcium with vitamin D supplementation for fractures in postmenopausal women have been used as preventive treatments.

However, at one new study from the Women’s Health Initiative published in the journal JAMAresearchers looked at these treatments and concluded that they can no longer support these therapies as preventive measures for certain diseases.

Clinical trials from the Women’s Health Initiative examined the health effects of various treatments for postmenopausal women:

  • Hormone therapy (estrogen) to prevent heart and other chronic diseases
  • Calcium and vitamin D supplements to reduce fractures
  • A low-fat diet with more fruits, vegetables and grains to prevent breast or colorectal cancer

The studies included 161,808 women aged 50 to 79 years, with a follow-up period of up to 20 years. The researchers noted that 55 million women in the United States and 1.1 billion worldwide are postmenopausal, and many have used at least one of these therapies to help improve their health.

Study participants received oral hormone treatment.

The researchers compared the cardiovascular health of those who received hormone treatment with those who received a placebo.

They said their findings do not support the use of hormone therapy to prevent cardiovascular disease, stroke, dementia or other chronic diseases. They added that the therapy significantly increased the incidence of breast cancer.

The scientists found that this treatment helped reduce vasomotor symptoms in early menopausal women. Vasomotor symptoms include hot flashes, night sweats, palpitations, and changes in blood pressure.

“Data on hormone therapy and calcium supplementation has been a roller coaster over the years,” says Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in California, who was not involved in the study. “One study shows that it works, another study shows that it doesn’t work. I like this study because it is a conglomeration of data that has been accumulating for years.”

“I think the data is quite compelling that hormone therapy should be used symptomatically, for example for vasomotor symptoms,” Weinberg told me. Medical news today. “But it is clear that it does not prevent cardiovascular disease. In the postmenopausal years, women’s bodies become more chemically aligned with men’s and so I am going to treat the symptoms accordingly. If someone has high blood pressure, I will treat it. If someone has high cholesterol, I will treat it.”

“Overall, I think this is a great study and provides very useful information for treating women at different stages of menopause,” Weinberg added.

Research from the 1980s and 1990s showed a reduced risk of heart disease in women who took hormone therapy, according to Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, who said didn’t. involved in the study.

However, more recent studies, Chen explained, did not yield the same results.

“For this reason, we have long recommended against the use of hormone replacement therapy for the prevention of heart disease,” Chen said. Medical news today.

“Our recommendations for reducing cardiovascular risk in postmenopausal women are essentially the same as those for the general public: eat a heart-healthy diet, get plenty of exercise, maintain a healthy weight, avoid tobacco and alcohol, get good sleep and take care of your health. blood pressure, blood sugar and cholesterol levels,” Chen added.

“(Using) estrogen and progesterone therapy in postmenopausal women, this combination appeared to significantly increase the risk of developing stroke or pulmonary embolism,” Chen noted.

The women in the new study received 1,000 milligrams of calcium and 400 IU/day of vitamin D daily.

The researchers assessed participants for hip fractures and reported that supplementation did not prevent these injuries in postmenopausal women. The researchers noted that women who do not meet national dietary guidelines might benefit from taking supplements.

According to the NIH Office of Dietary Supplements, the recommended daily intake is calcium and vitamin D 1,200 mg/day And 600 IU/dayfor women aged 51 to 70 respectively.

Additional research published in March 2024 found that calcium and vitamin D supplementation in postmenopausal women could reduce the risk of death from cancer, but potentially increase the risk of death from cardiovascular disease.

The participants in this new study followed a diet that reduced their fat intake by about 20%. They also increased their fruit and vegetable intake to at least five servings per day and their grain intake to at least six servings per day.

The researchers assessed these women for the incidence of breast or colorectal cancer.

They reported that the low-fat diet did not significantly reduce the incidence of these cancers. However, long-term follow-up showed that breast cancer mortality decreased.

The scientists did indicate that the diet may be an option for postmenopausal women who want to reduce their risk of death from breast cancer.

“Perimenopause marks a period of transition and transformation for women, characterized by hormonal fluctuations that affect different parts of the body, including the brain,” says Dr. Adi Katz, director of gynecology at Northwell Lenox Hill Hospital in New York, who is not was involved in the research, said Medical news today. “Research has linked these hormonal changes to conditions such as PCOS (polycystic ovary syndrome), PMDD (premenstrual dysphoric disorder) and PMS (premenstrual syndrome), which can increase the risk of anxiety and depression. It is crucial to destigmatize these experiences and provide support for women during this important stage of life.”

The researchers noted several limitations to their study:

  • They used the most common hormone therapy treatment in the study. However, there may be additional formulations that may produce different or better results.
  • Calcium and vitamin D supplements not included in the study may have affected the results.
  • The low-fat diet did not meet the target of 20% of total calories and the scientists could not distinguish the effects of reducing fat from the impact of increasing fruits, vegetables and grains.