Hormone replacement therapy for postmenopausal women has won some advocates who regard it as a way to further reduce heart disease deaths, which have been declining in Australia and much of the Western world since the 1960s. Studies of postmenopausal women prescribed oestrogen in pill form consistently show a significant reduction (by about 20 to 50 per cent) in the risk of heart disease for these women compared with women not taking oestrogen.
Knowledge of how this protective effect works is increasing, especially oestrogen's favourable impact on blood fats, including cholesterol, and its capacity to reduce heart disease risk by preventing the gradual build-up of fatty material inside blood vessel walls (known as atherosclerosis). It also seems to increase the width of the small blood vessels, enhancing blood flow and reducing the risk of clot formation and life-threatening blood vessel blockage.
Natural oestrogens in pill form seem to have greater benefits for the heart than oestrogen in other forms (implants, patches, vaginal creams and pessaries, for example), but the research is at an early stage. In addition, there are unanswered questions about dosage and duration of use.
The relationship between heart disease and the use of hormone preparations that combine oestrogen and progestogens is not conclusive. The studies performed to date have been short-term and confined in the main to women who are in good general health, are well educated and well off. No information is yet available regarding the long-term effects that these hormone combinations have on a woman's risk of developing heart attacks, strokes and blood clot disorders. There have been some encouraging animal studies that suggest that pairing these hormones does benefit the lining of blood vessels. However, a number of short-term studies on women suggest that progestogens in higher-than-HRT doses reduce the degree of benefit provided by oestrogen.
There is strong evidence that oestrogen may protect women with pre-existing heart and blood vessel disease from a further deterioration in their condition. There are also early indications that oestrogen reduces the tendency of major blood vessels to spasm in women prone to the excruciating heart pain, angina.
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Tags: Hormonal
Tags: Hormonal