Research presented at the 2024 Annual Meeting of The Menopause Society in Chicago aimed to uncover the impact of hormone replacement therapy (HRT) on various aspects of health. One study reported that extended use of some hormone therapies can improve markers of cardiovascular health at menopause, while a large meta-analysis found that HRT can help improve insulin sensitivity by restoring estrogen levels. Hormone therapy works by restoring levels of different hormones in the body, which tend to decrease with age, and are often responsible for many of the symptoms associated with menopause. However, debates abound about which types of HRT are safe and the potential long-term impact of HRT on health.
A study presented at the meeting found that estrogen-based hormone therapy appeared to have a positive long-term effect on almost all markers of cardiovascular health. The study used data from the Women’s Health Initiative and compared cardiovascular health biomarker values in participants who were taking certain estrogen-based hormone therapies versus a placebo. It was found that those who took specific hormone therapies experienced increases in “good” cholesterol levels and decreases in “bad” cholesterol levels. The study also found that markers of insulin resistance were lower in participants on HRT. However, triglyceride levels showed no improvement with HRT.
Research has shown that the drop in estrogen levels that occurs during menopause can increase a person’s risk of heart disease and cardiovascular problems. This drop leads to changes such as increased artery plaque buildup, cholesterol levels, and blood pressure, which can all contribute to heart disease risk. Therefore, supplementing estrogen levels through HRT can help improve markers of cardiovascular health by restoring elasticity in blood vessels and promoting healthy cholesterol levels. It is recommended to start estrogen replacement therapy as menopause begins to optimize cardiovascular benefits.
Another study presented at the meeting suggested that HRT was associated with lower insulin resistance in women at postmenopause. A review and meta-analysis of 17 randomized controlled trials found that all HRT studies, whether administered orally or transdermally, were associated with improved insulin sensitivity at postmenopause. This improvement in insulin sensitivity could have a protective effect against diabetes. HRT, including estrogen and progesterone medication, can improve metabolic health by regulating insulin production, maintaining body weight and fat distribution, and reducing the risk of type 2 diabetes.
While there are positive findings about the benefits of HRT, doctors caution that some therapies may affect individuals differently and come with potential side effects. Oral preparations of HRT can increase the risk of blood clots due to increased platelet aggregation, while transdermal HRT tends to have less of an effect on platelet aggregation. The choice of HRT should be based on resolving the specific symptoms that concern the individual with the lowest medication dosage. HRT can also play a crucial role in reducing the risk of osteoporosis in women at risk, but those with certain health conditions, such as a history of blood clots, stroke, heart disease, or breast cancer, may not be candidates for HRT.
There are still questions about the long-term health impact of HRT for menopause symptoms, such as whether HRT should be stopped after the age of 60 to avoid increasing breast cancer risk, whether HRT should be taken preventively for heart health support, whether it can help with brain health and lower dementia risk, and whether pellet or compounded forms of HRT are safe. It is important for individuals to receive specialized medical advice to make the best decisions for their personal health. Doctors remain concerned about the potential risks of long-term HRT treatment, such as blood clots, stroke, and breast cancer, so discussing any questions or concerns with a healthcare provider is crucial in making informed decisions about HRT.
