After menopause, women are at higher risk for a number of health conditions, including cardiovascular disease.  Doctors want to make sure that any treatment given to a patient because of menopause does not further increase these risks.
Updated guidelines state that menopausal hormone therapy is the most effective treatment for relieving menopausal symptoms.
The researchers found that long-term data showed that short-term hormone therapy in menopause is not associated with increased cardiovascular risk when prescribed appropriately in women who are not at high risk for heart problems.
However, if women start menopausal hormone therapy 10 or more years after menopause, they may be at increased risk for adverse cardiac events.
Dr. Beth Abramson, a cardiologist, professor at the University of Toronto and one of the authors of the new guidelines, told CTVNews.ca in a phone interview that each patient has unique risks and circumstances they must weigh, but these guidelines help doctors they have the tools to understand them.
“There have been several studies and analyzes that have come out in recent years to inform and appropriately give healthcare providers the information to talk to their female patients,” she said.
“Women under the age of 60 who took hormone therapy in menopause that started shortly after their last period did not appear to have an increased risk of cardiovascular disease.  And we’ve seen in general that there’s a low risk of adverse events, including stroke, over the next few years.”


WHAT IS HORMONE THERAPY OF THE MENSPAUSIS? 
Menopause marks the end of the stage in a woman’s life when she has menstrual periods and can become pregnant, usually experienced in middle age.
During this transition, the body’s production of estrogen and progesterone varies greatly, and after menopause, a woman’s body will produce much less estrogen.  Menopause can sometimes be triggered by the removal of the ovaries or certain ovarian diseases or cancers.
While some women experience few symptoms during their menopausal or perimenopausal years, others may experience a range of symptoms including hot flashes, vaginal dryness, sleep problems, bladder control problems, mood swings and chills, among others.
“If a woman has these symptoms and they are severe, treatment may be indicated for one’s quality of life,” Abramson said.
According to Mount Sinai Hospital, about 80 percent of women have some menopausal symptoms, and 20 percent of those women experience severe symptoms.
The most effective treatment for those with severe symptoms is menopausal hormone therapy (MHT), according to the guidelines.
It works by giving menopausal women estrogen, usually combined with progesterone, that the body no longer produces.
“It gives back the estrogen that runs out or drops when a woman’s body changes after middle age,” Abramson said.
But there are considerations to be made when prescribing MHT.
“Estrogen is a hormone, and a hormone by definition has multiple effects on the body,” Abramson said.  “And the thing about estrogen is that there is a consistently small, but significant, increased risk of blood clots in the legs and lungs.  We call it a venous thromboembolism.  This must be weighed against the risk of benefit to the individual patient.
“And so our instructions looked at the evidence before us.  I think we’re a lot more informed than we were a decade or so ago.”


DESTRUCTION OF INSTRUCTIONS 
The new guidelines, written in collaboration with the Society of Obstetricians and Gynecologists of Canada and presented this weekend at the Canadian Cardiovascular Congress in Ottawa, are aimed at physicians, family physicians, nurses, pharmacists and other health professionals.
The researchers consulted relevant studies published in PubMed, MEDLINE and the Cochrane Library between 2002 and 2020 to inform the guidelines.
They found that short-term menopausal hormone therapy was not associated with increased cardiovascular risk in appropriately selected patients.
Abramson explained that short-term means that MHT is not taken for an extended period of time or indefinitely.
“So we’re not talking about 10 years of treatment, for example,” he said.  “Most of the data suggesting safety is looking at women who had about five years of treatment and then stopped.”
The data they looked at continued to follow patients for years after stopping MHT, up to 18 years later in some studies, to measure whether there were long-term risks.
Those studies showed “no increased risk of heart attack or stroke in these women,” Abramson said.
The guidelines suggest that doctors who have decided that MHT is right for their patient should prescribe the lowest dose of estrogen that still treats a person’s symptoms in order to minimize the risk of stroke and blood clots.
The researchers also found that giving MHT to women who had entered early menopause, and continuing to give this treatment until mid-menopausal age, appeared to reduce the risk of adverse cardiovascular outcomes.
The average age of menopause is around 51.
Previous research has found that women who start experiencing menopause early may be at increased risk of coronary heart disease.
“We certainly know that older women who are over 60, who have been out 10 years after menopause, have a higher risk of blood clots, and we don’t recommend menopausal hormone therapy in general (for them).”  Abramson said.
He added that it is important to note that MHT is intended for the relief of symptoms associated with menopause, not for the purpose of preventing cardiovascular disease, and is not recommended for this.
Abramson noted that more research still needs to be done to evaluate the MHT delivery method.
“There’s a lack of high-quality data looking at the types of estrogen we should be giving our women, either orally or in a patch over the skin, for women at average cardiovascular risk, and I think there’s room for continued research to evaluate that “, he said.
While the new guidelines themselves aren’t much different from the older 2014 guidelines, they have a lot more data to support them, Abramson said, particularly in assessing individual risk and benefit.
Many women will never need MHT, but the option is there for those who do.  This ongoing research helps ensure that doctors are able to help patients make these decisions, experts say.
“I think a woman who has symptoms should talk to her doctor, because we have the data to have an intelligent and informed conversation to make sure that woman is aware of the risk versus the benefit,” Abramson said.
“If we don’t talk, we can’t heal.”