Hormone Therapy Potentially Enhances Cardiac Health in Menopausal Women

Deciding whether to initiate hormone therapy during menopause, the transitional phase ending a woman's reproductive years, remains a topic of considerable debate. While hormone therapy is commonly recommended for alleviating bothersome symptoms such as hot flashes and night sweats, questions persist regarding its long-term effects, especially concerning cardiovascular health. According to Matthew Nudy, an assistant professor of medicine at Penn State College of Medicine, there is ongoing confusion about how hormone therapy impacts heart health over time.

Recent research conducted by a collaborative team analyzed data from clinical trials within the Women's Health Initiative (WHI), a significant long-term study focusing on postmenopausal women. The findings suggest that long-term use of estrogen-based hormone therapies could confer cardiovascular benefits. The study observed that women undergoing hormone therapy showed improvements in key biomarkers associated with heart health, notably a reduction in lipoprotein(a)—a genetically determined particle linked to increased risk of heart attack, stroke, and aortic valve disease.

Published in the journal Obstetrics & Gynecology, the research indicates hormone therapy may lower levels of LDL 'bad' cholesterol, total cholesterol, and insulin resistance, while increasing HDL 'good' cholesterol. Interestingly, levels of triglycerides and blood clotting proteins increased, which warrants further study. Significantly, lipoprotein(a) levels decreased by 15% to 20% in women receiving estrogen alone or combined with progesterone. Since lipoprotein(a) is primarily influenced by genetics and has limited medication options to lower it, this finding could have important implications for cardiovascular risk management.

The study also revealed racial and ethnic differences, with more pronounced decreases in lipoprotein(a) in women of American Indian, Alaska Native, or Asian/Pacific Islander descent. These results open avenues for further research into personalized approaches to hormone therapy.

Nudy emphasized that the estrogen used in the trial was conjugated equine estrogens, administered orally, which undergoes first-pass metabolism in the liver, potentially increasing inflammatory markers like triglycerides. He highlighted that transdermal estrogen, applied through the skin, does not have this effect and could be a preferable option.

He recommends that women considering hormone therapy undergo a cardiovascular risk assessment, which can help tailor treatment options despite current limitations, such as the lack of FDA approval for hormone therapy specifically to reduce heart disease risks. As research progresses, hormone therapy could become a more nuanced tool in managing both menopausal symptoms and long-term heart health.

Source: https://medicalxpress.com/news/2025-04-hormone-therapy-heart-health-menopausal.html