Research presented at the 2024 Annual Meeting of The Menopause Society in Chicago has 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. A large meta-analysis further found that HRT can help improve insulin sensitivity by restoring estrogen levels, which tend to decrease with age. This process is often responsible for many of the symptoms associated with menopause. Debates abound about which types of HRT are safe and the potential impact of prolonged use of HRT on health. One 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 led by researchers from Penn State Hershey Medical Center used data from the Women’s Health Initiative (WHI) and compared cardiovascular health biomarker values in participants who were taking certain estrogen-based hormone therapies versus a placebo. The researchers found that those who took conjugated equine estrogens for at least 1 year saw a 13% increase in high-density lipoprotein cholesterol (HDL-C), also known as “good cholesterol.” So-called bad cholesterol (LDL-C) decreased by approximately 11% in both HRT groups. In particular, Lipoprotein(a) or Lp(a) — a form of LDL-C strongly associated with a range of cardiovascular problems — decreased by 15% in those taking conjugated equine estrogens alone. For those taking plus medroxyprogesterone acetate, the decrease in Lp(a) level was even greater—at 20%. The researchers also found that markers of insulin resistance were lower in those on HRTs, decreasing by 14% in participants taking conjugated equine estrogens only and by 8% in those taking conjugated equine estrogens with medroxyprogesterone acetate.
Due to the hormonal changes that occur during menopause, the risk of heart disease and cardiovascular problems increases. Estrogen levels drop during menopause, leading to changes such as increased artery plaque buildup, cholesterol levels, and blood pressure, all of which can increase the risk of heart disease. Estrogen production helps maintain elasticity in blood vessels, reduces LDL cholesterol, and promotes HDL cholesterol production. These mechanisms could explain why long-term estrogen supplementation in the study led to improvements in biomarkers of cardiovascular health. Estrogen replacement therapy can help by bringing back the benefits of elasticity in blood vessels, reducing LDL levels, and promoting HDL levels, supporting heart health.
Researchers from Reading Hospital Tower Health, Drexel University College of Medicine, and other institutions presented findings suggesting that HRT was associated with lower insulin resistance in women at postmenopause. A review and meta-analysis of 17 randomized controlled trials with a total of 29,287 participants found that all HRT studies were associated with improved insulin sensitivity at postmenopause. Improvements in insulin sensitivity that come with HRT could have a protective effect against diabetes. HRT regulates insulin production, maintains body weight and fat distribution, and reduces the risk of type 2 diabetes. Even with these positive findings, doctors caution that some HRT therapies may affect individuals differently and come with their own set of side effects.
Doctors emphasize the importance of individualized treatment when considering HRT. Oral preparations of HRT may have risks of increasing clotting in small blood vessels due to being metabolized in the liver, while transdermal preparations may avoid liver metabolism and have fewer side effects. Each woman should be treated individually and given the lowest dose of HRT that resolves her symptoms. HRT can play a crucial role in reducing the risk of osteoporosis, preventing bone loss, and fractures. However, women with increased risks of blood clots, stroke, ischemic heart disease, or breast cancer may not be suitable candidates for HRT. It is recommended to discuss concerns and questions about HRT with a healthcare provider to make the best decision for personal health.
Some questions about the long-term health impact of HRT for menopause symptoms remain unanswered, such as whether a person should stop HRT after the age of 60 to avoid increasing the risk of breast cancer, whether HRT should be taken preventively for heart health support even without disruptive menopause symptoms, and whether HRT can be used in pellet form or compounded safely. Concerns persist about long-term HRT treatment increasing the risk of blood clots, stroke, and breast cancer. Specialized medical advice that considers individual circumstances is crucial for deciding on HRT. Discussing any questions or concerns about HRT with a healthcare provider is important to make informed decisions regarding personal health.
