By Mary Kundert, PharmD

The Corner Pharmacist

Due to the announcement made last month by the American Heart Association, this column will address hormone replacement therapy (HRT) and cardiovascular disease in women.

Dear Mary,

I’ve been taking female hormones for several years. At first, it was to control some of my problems with menopause. For the past two years, my doctor suggested that I continue on them because it was good for my heart and bones. Now I hear they may not be benefiting my heart. I’m so confused! Could you please explain?

Nancy

Los Altos

Dear Nancy,

I understand your frustration. It seems like every few years there are changes in opinion about the safety of HRT. But what’s important about this latest information is that the data is based on good science, where the women were randomly assigned to be given either an active drug or a placebo. In the past, researchers would collect data from women who were already on HRT, and it appeared that the hormones were reducing their risk of heart disease. Now it seems that women who opt for HRT may be more health conscious in the first place, and it may have been their lifestyles that helped their hearts, not the hormones.

In this new study, published in the July 24 issue of the American Heart Association’s journal Circulation, researchers found no difference between both groups (active drug vs. placebo) in the number of heart attacks after four years. There was an increased risk of heart attack and blood clots observed in the first year among the hormone group, though this risk appeared less likely after several years of HRT.

What does all this mean? In my opinion, we still don’t know the whole story on HRT and its overall effects on disease, both good and bad. Clearly, there are many benefits when treating peri-menopausal symptoms. Short-term (less than five years) use is probably reasonable with women who have no history of cardiovascular disease, breast cancer, uterine cancer or liver disease. But long-term use is not risk free. Doctors are now likely to recommend that women who have been on HRT for several years without complications can continue, but that women should not begin HRT to prevent heart disease.

What about osteoporosis? Stay tuned. I suspect we’ll be hearing more on this very soon.

In closing, let’s look at the alternative. For most women, it’s those dreaded words “diet” and “exercise” again. Those, plus a few vitamins and minerals, and women could drastically improve their overall health while reducing the risk of developing either heart disease or osteoporosis. There are many other alternatives in the treatment of menopause, if you’re inclined to go that route.

Kundert is available by appointment for 10-minute consultations sponsored by Los Altos Pharmacy.