Abstract
Reports have correlated the use of estrogen for the treatment of menopausal symptoms with beneficial effects on the cardiovascular system. Molecular, biochemical, preclinical, and clinical studies have furnished a wealth of evidence in support of this outcome of estrogen action. The prospective randomized Women’s Health Initiative (WHI) and the Early Versus Late Intervention Trial (ELITE) showed that starting menopausal hormone treatment (MHT) within 5 to 10 years of menopause is fundamental to the success of estrogen’s cardioprotection in post-menopausal women without adverse effects. Age stratification of the WHI data has shown that starting hormone treatment within the first decade after menopause is both safe and effective, and the long-term WHI follow-up studies are supportive of cardioprotection. This is especially true in estrogen-treated women who underwent surgical menopause. A critique of the WHI and other relevant studies is presented, supporting that the timely use of estrogens protects against age- and hormone-related cardiovascular complications. Salutary long-term hormone treatment for menopausal symptoms and prevention of complications has been widely reported, but there are no prospective trials defining the correct length to continue MHT. At present, women undergoing premature menopause receive estrogen treatment (ET) until evidence of hormone-related complications intervenes. Normal women started on MHT who receive treatment for decades without hormone-related complications have been reported, and the WHI follow-up studies are promising of long-term post-treatment cardioprotection. A prevention-based holistic approach is proposed for timely and continuing MHT/ET administration as part of the general management of the menopausal woman. But this should be undertaken only with scheduled, annual patient visits including evaluations of cardiovascular status. Because of the continued occurrence of reproductive cancers well into older ages, these visits should include genital and breast cancer screening.
Highlights
The age-related cessation of ovarian follicle development and surgical removal of the ovaries are followed by dramatic declines of circulating estrogens, especially estradiol
If the menopausal hormone treatment (MHT) is begun within the first few years after menopause, the benefits far outweigh the risks for most women
There are many other treatment regimens that either are not relevant to the specific question of cardiovascular health or were not included because of the paucity of type 1 trial data. To peruse this important subject, we suggest that the reader begin with the current American College of Obstetricians and Gynecologists Practice Bulletin[59]
Summary
The age-related cessation of ovarian follicle development and surgical removal of the ovaries are followed by dramatic declines of circulating estrogens, especially estradiol. The Kronos Early Estrogen Prevention Study (KEEPS) lowdose MHT trial, though showing improvement of risk factors for CVD, failed to show a slowing of the increase of CIMT by 4 years of estradiol-plus-progesterone treatment This may have been due to the inability of CIMT measurements to reveal cardioprotection that occurred during the 4 years of the trial[67] since the ELITE study confirmed that even normal CIMT women have increases in their CIMT after menopause. We believe that the reason for the lack of similar findings in the KEEPS was the exclusion of test subjects who had evidence of sub-clinical CVD (CAC of ≤ 50 Agatston units) at the time of registration[67] At this point, there are no published prospective studies regarding the limits of estrogen-induced cardioprotection in women starting MHT within 10 years of menopause. All authors contributed directly to the development and content of the manuscript
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
