Timing, Dosage of HRT Affect Chances of Heart Trouble

Large study found younger women taking it for a longer time did have higher risk

By Amanda Gardner
HealthDay Reporter

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WEDNESDAY, Oct. 1 (HealthDay News) -- The largest observational study of hormone replacement therapy since the landmark Women's Health Initiative finds that how and when women take hormone replacement therapy affects their heart attack risk.

Younger women had a higher risk of heart attacks, especially younger women who took hormone replacement therapy (HRT) for a long time, Danish researchers found. Certain formulations also lead to different results.

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"For women with an intact uterus, cyclic combined therapy (causing menstrual bleedings) should be preferred instead of continuous combined therapy (not causing menstrual bleedings)," said Dr. Ellen Lokkegaard, lead author of the study published online Oct. 1 in the European Heart Journal. "And for women without a uterus, dermal application via gel or patch is associated with a lower risk."

"The regimen and route of administration should be considered carefully when HRT is administered," concluded Lokkegaard, who is a gynecologist at the Rigshospitalet in Copenhagen, Denmark.

A section of the U.S. government-sponsored Women's Health Initiative (WHI), which was designed to look at health issues in postmenopausal women, was halted in 2002, when U.S. researchers found that HRT led to an increased risk of adverse events that included heart attack, stroke, breast cancer and blood clots. The risk depended on whether the woman was taking estrogen alone or estrogen plus progesterone, another female hormone.

Since that time, however, a more complex picture has emerged with various factors, including amount of hormone as well as timing of use, determining the exact nature of risks and benefits.

Previous research indicated that HRT might have a negative effect on cardiovascular health in women who started therapy long after menopause, versus women taking it sooner after menopause.

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