For postmenopausal women with bothersome symptoms, HRT is safe when prescribed appropriately. Explanations.
Your gynecologist is offering you menopausal hormone therapy (MHRT), but you’ve heard negative information about it. It’s true that in 2002, an American study, the Women’s Health Initiative (WHI), discredited it: it showed a higher risk of breast cancer and cardiovascular accidents in women treated, compared to those taking a placebo.
A result that is all the more destabilizing since it was then assumed that the estrogens in HRT conferred cardiovascular protection. But a re-examination of the data showed that the patients in this study had started HRT at an average age of 63, or about ten years after menopause.
However, at this age, aging arteries, and the atheroma plaques that go with them, are weakened by estrogen. This explains a higher rate of cardiovascular accidents. Since then, several studies have made it possible to establish recommendations.
Not at any age
“THM should be prescribed at the start of menopause and before the age of 60”explains Dr. Brigitte Letombe, medical gynecologist, member of the office of the Study Group on Menopause and Hormonal Aging (GEMVi) and co-founder of the All for Menopause collective.
A comparison between the benefits of treatment and its risks (the “benefit/risk balance”) always shows greater benefits, “especially on the cardiovascular level, she completes. But of course, it has to be re-evaluated every year.”. Risks may become greater over time, “especially those over sixty”.
ALSO READ >>> Women’s hearts, the great forgotten of prevention
Depending on the background
HRT should not be prescribed to women who have already had a cardiovascular accident or hormone-dependent cancer, or who have severe dyslipidemia, uncontrolled diabetes or serious liver disease. “These are absolute red lights”insists cardiologist Claire Mounier-Véhier, co-founder of the endowment fund Agir pour le Cœur des Femmes. On the other hand, HRT can be prescribed without concern to women at low risk of breast or cardiovascular cancer.
And if you are a smoker, diabetic, hypertensive, overweight or have another risk factor, “It is then necessary to carry out a complete cardiovascular assessment and decide on a case-by-case basis.”says Claire Mounier-Véhier. This concerns the majority of women who often present, at the age of the possible prescription, several cardiovascular risk factors: smoking, diabetes, high blood pressure, dyslipidemia, overweight, sedentary lifestyle; or also migraine with aura, history of hypertension or diabetes during pregnancy…
In what form?
If you are eligible, MHT will be taken in the form of a gel to be applied every day or a patch to be changed every three to five days, to which is added (except in the case of hysterectomy) natural progesterone in tablet form. Oral estrogen administration is strongly discouraged, as it increases the risk of phlebitis, pulmonary embolism, coronary events, strokes and hypertension.
READ ALSO >>> Osteoporosis: It’s never too early for screening
