A study published in the journal “JAMA Internal Medicine” examined data from more than 2,700 women experiencing perimenopause or who had recently reached menopause. Perimenopause is the transitional period before menopause when estrogen levels begin to fluctuate. It usually starts when a woman reaches her forties and can last several years.
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All study participants experienced hot flashes or night sweats. At the start of the study, none of them had cardiovascular diseases or were using hormone therapy. The women were followed for about 20 years, according to “Everydayhealth”.
The risk was 22% lower
Data analysis showed that women who started hormone therapy during perimenopause or the early postmenopausal period had a 22% lower risk of cardiovascular events, such as heart attack or stroke, compared to those who did not use this treatment.
Menopause is diagnosed when a woman has not had a menstrual period for 12 months. Among women who started treatment after menopause, the greatest difference was observed considering the elapsed time.
Women who started hormone therapy within the first decade after the onset of menopause had a 27% lower risk of cardiovascular diseases than those who started treatment after ten or more years. No heart-beneficial effects were found in those who started treatment later.
“Until now, no one has examined whether the timing of hormone therapy initiation during perimenopause could be important for cardiovascular disease risk. These are significant findings,” said Lauren Streicher, a professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, who was not involved in the study.
Changes during menopause affect more than just well-being
As estrogen levels decrease, changes related to cardiovascular health may occur. Laxmi Mehta, a cardiologist at Ohio State University’s Wexner Medical Center, highlighted several key points:
- the level of low-density lipoproteins, known as “bad” cholesterol, may increase;
- blood pressure may rise;
- body fat may increase;
- blood vessels may become stiffer, and the function of the endothelium lining their inner surface may be impaired.
All these changes can contribute to a higher risk of cardiovascular diseases. However, study co-author and epidemiologist Samar R. El Khoudary emphasized that menopause is a complex biological process. It is not yet fully clear how changes in different hormones and other physiological processes interact and affect the heart.
How can estrogens affect the heart?
Estrogens are believed to help maintain blood vessel elasticity, reduce “bad” cholesterol, and increase high-density lipoproteins, or “good” cholesterol. Hormone therapy supplements the decreasing estrogen levels, so it may be associated with these positive changes.
However, the study involved women experiencing hot flashes and night sweats. Specialists do not rule out that the benefits may be related not only to estrogens but also to symptom relief.
Frequent hot flashes are associated with increased inflammatory activity and insulin resistance. Night sweats also disrupt sleep, and long-term sleep deprivation is unfavorable for metabolism and heart health.
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“Frequent hot flashes put a strain on the vascular system. Reducing these symptoms may decrease the stress on blood vessels, improve sleep, and overall heart and metabolic health,” explained L. Mehta.
However, it is not yet possible to say precisely whether the observed difference resulted from the direct effect of estrogens or because hormone therapy reduced bothersome symptoms.
The study does not prove causation
The study was observational, so its results show an association but do not prove that hormone therapy specifically reduced the risk of cardiovascular diseases.
The so-called healthy user effect may also have played a role. Women who take better care of their health may be more likely to see doctors, take prescribed medications, eat healthier, and exercise more. All of this could also have influenced the lower risk of heart disease.
Since the study included only women who experienced hot flashes or night sweats, it is unclear whether similar results would be obtained when studying women without these symptoms.
Not a preventive measure for heart diseases
The study authors emphasize that the new findings do not mean hormone therapy should be prescribed solely to protect the heart. The decision depends on a woman’s symptoms, age, time elapsed since menopause onset, health history, and individual risk factors.
“The overall balance of benefits and risks is different for each woman,” stressed S. R. El Khoudary.
However, hot flashes and night sweats should not simply be endured. According to L. Mehta, menopause is an important time to discuss with a doctor not only symptom treatment but also cholesterol levels, blood pressure, and overall cardiovascular risk.
Treatment options can be hormonal and non-hormonal. The most appropriate method should be chosen individually by the doctor, considering the woman’s symptoms and health status.
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