Physical Health

Click on the topics that interest you below:

Hormone Therapy and Heart Disease

Cardiovascular disease, which includes coronary heart disease, high blood pressure, stroke, angina (chest pain) and rheumatic heart disease, threatens the lives of millions of women each year. In fact, heart disease is the number one killer of women. As you age, your risk for cardiovascular disease increases, and therefore older women may have a greater risk profile than younger women when starting hormone therapy. Many researchers believe estrogen has a protective effect on your heart and blood vessels that may be lost once menopause begins.
The American Heart Association states that hormone therapy should not be used to prevent or treat heart disease. The Kronos Early Estrogen Prevention Study (KEEPS) evaluated the results from healthy young women taking a placebo vs. hormone therapy and discovered there was no increase in cardiovascular risk in the study population, but more research is needed.  Data supporting the timing hypothesis which proposes that cardiovascular risk may be reduced if HT is initiated soon after menopause begins (rather than many years later) is being collected in the ELITE (early versus Late Intervention Trial with Estradiol).
If you have existing plaque in your arteries, hormone therapy may cause an additional risk for cardiovascular disease and will not prevent any further cardiovascular damage. Cardiovascular risk also depends on lifestyle factors such as exercise and tobacco use, genetics and previous cardiovascular health.
Some of the factors that may increase your risk for heart disease include:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking/tobacco use
  • Overweight
  • Little or no physical activity
  • Family history of heart disease
  • Age (women over 55 are particularly susceptible)
  • Existing heart disease (such as heart attack, bypass surgery)
  • Stroke or carotid artery disease
  • Blocked arteries in legs
  • Chronic kidney disease

To calculate your own heart disease risk, click here to go to the American Heart Association and take the Heart Risk Assessment Tool and share the results with your OB/GYN or healthcare provider.

Hormone Therapy and Stroke

As you age and go into menopause, your risk for stroke increases. Although more men have strokes than women, more women die from strokes. An ischemic stroke occurs due to blockage—commonly a clot—in the blood vessels that carry oxygen to the brain. A hemorrhagic stroke occurs when a blood vessel ruptures. When the blood flow and oxygen to the brain is blocked or stopped, the risk of brain damage increases.

The North American Menopause Society (NAMS) and American Heart Association (AHA) state that using hormone therapy slightly increases the risk of stroke and blood clots for women. However, younger women taking hormone therapy within 5 years of menopause demonstrated no significant increase in stroke. If you smoke and use hormone therapy, or have risk factors for stroke or blood clots, the risks could outweigh the benefits for your overall health. Low-dose oral estrogen or estrogen therapy delivered transdermally (through the skin) by patch, cream, gel or spray may have a lower risk of blood clots and stroke than standard doses of oral estrogen, although all the evidence is not yet available.

Risk factors for stroke include:

  • Age—after 55, the risk for stroke nearly doubles
  • Family history of stroke or blood clot
  • African-Americans have twice the risk of stroke compared to Caucasians
  • Hispanic and Asian/Pacific Islanders also have a higher risk than Caucasians
  • High blood pressure
  • Little or no physical activity

To learn more about your risk of stroke, click here to take the American Heart Association's stroke and heart health risk assessment.

Hormone Therapy and Breasts

Women have a 1 in 8 chance of developing breast cancer in their lives. This risk increases as you age, or if you have a history of breast cancer. Some research shows that the earlier a woman enters menopause (before 45), the lower her risk for breast cancer since her lifetime exposure to estrogen is less than a woman who enters menopause at 55 or older.

The current North American Menopause Society (NAMS) position states that hormone therapy should not be used to prevent a new or recurrent breast cancer diagnosis. For women who continually use estrogen progestin therapy (EPT) for 5 or more years, an increased risk of breast cancer is seen—possibly even earlier than 5 years. For women who use estrogen therapy (ET) for an average of 7 years, researchers saw no increased risk for breast cancer.  Progesterone alone increases breast cancer risk.

To minimize your risk for breast cancer, take hormone therapy for menopausal symptoms when you are younger. If you are planning to take EPT, use it for the shortest necessary amount of time. If you have undergone chemotherapy for a previous breast cancer diagnosis, using estrogen therapy (ET) can increase the risk for another cancer diagnosis.

Here are some of the factors that could increase your risk for breast cancer:

  • Maternal or paternal history of breast cancer in a first relative (mother, sister, daughter)
  • Increased breast density in mammogram
  • Obesity
  • Frequent alcohol use
  • Little or no physical activity
  • Age
  • Number of breast biopsies, especially if atypical hyperplasia is found

Some factors that reduce your risk for breast cancer include:

  • Early age of first full term pregnancy
  • Long-term breast feeding
  • Frequent exercise
  • No personal or family history or breast disease

To assess your risk for breast cancer while using hormone therapy, click here.

Hormone Therapy and Bones

For men and women, the risk of bone loss, osteopenia and osteoporosis increases with age. Menopausal women are particularly at risk due to estrogen loss. Although bone loss typically begins at age 30 for women, if you enter menopause early (prior to 45), you are likely to experience bone loss more rapidly than women entering menopause when they are older.

By the time you are postmenopausal, your rate of bone loss exceeds the rate of your new bone formation and your bone mineral density (BMD) decreases rapidly.

The National Osteoporosis Foundation states that for menopausal and postmenopausal women, both types of hormone therapy—ET and EPT—may help reduce your risk for osteoporosis by slowing the rate of bone loss. Hormone therapy can also help reduce the risk or fractures and injuries from osteopenia, osteoporosis and BMD. Hormone therapy should not be used to treat existing osteoporosis symptoms or significantly low BMD.

Here are some of the factors that can increase the risk for osteoporosis and BMD:

  • Women are more likely than men to get osteoporosis
  • Age—bone density decreases with age
  • Family history of osteoporosis
  • Decreased levels of estrogen
  • High levels of thyroid hormones
  • Smaller or shorter people have an overall lower bone mass
  • Insufficient Vitamin D
  • Low calcium
  • A history of eating disorders, such as anorexia
  • Frequent alcohol consumption
  • Tobacco use
  • Drug abuse
  • Little or no exercise
  • Beginning menopause with a low bone mass increases your risk for osteoporosis


Hormone Therapy and Urogenital Health

As a woman transitions through menopause, estrogen depletion may cause changes in her vagina and urinary system. Recently, a new term, Genitourinary Syndrome of Menopause (GSM), has been introduced  for symptoms involving these organs. These changes can be described as vaginal or genital atrophy—the progressive decline and thinning of vaginal tissue and decrease in vaginal acidity and elasticity due to estrogen loss. Embarrassment leads to underreporting of these problems.

Here are some of the symptoms you may experience:

  • Vaginal dryness
  • Itching
  • Incontinence/urinary leaking
  • Discomfort during intercourse
  • An increase in vaginitis, vaginismus and urinary tract infections
  • Discomfort/pain in the vulva or pelvis

To treat these symptoms, all forms of hormone therapy to treat hot flashes and night sweats can also treat your vaginal dryness. But if urogenital issues are more troubling, you may want to add a low dose of local estrogen in the form of creams, tablet or vaginal ring. These localized forms of estrogen are often the preferred treatment if vaginal atrophy is your only menopausal symptom and may benefit an overactive bladder.