Cardiovascular disease
Cardiovascular disease is the principal cause of morbidity and mortality in postmenopausal women. Major primary prevention measures (besides smoking cessation and diet control) are weight loss, blood pressure reduction, and diabetes and lipid control. There is evidence that HT may be cardioprotective if started around the time of menopause and continued long-term (often referred to as the window of opportunity concept). HT markedly reduces the risk of diabetes and, through improved insulin resistance, it has positive effects on other related risk factors for cardiovascular disease such as the lipid profile and metabolic syndrome.
In women less than 60 years old, recently menopausal and without prevalent cardiovascular disease, the initiation of HT does not cause early harm and in fact reduces cardiovascular morbidity and mortality. Continuation of HT beyond the age of 60 should be decided as a part of the overall riskbenefit analysis.
Other benefits
HT has benefits for connective tissue, skin, joints and intervertebral disks. HT may reduce the risk of colon cancer. HT initiated around the time of menopause or by younger postmenopausal women is associated with a reduced risk of Alzheimers disease.
POTENTIAL SERIOUS ADVERSE EFFECTS OF HORMONE THERAPY
Studies on the risks of postmenopausal hormone use have mainly focused on breast and endometrial cancer, venous thromboembolism (pulmonary embolism or deep vein thrombosis), stroke and coronary events.
Breast cancer
The incidence of breast cancer varies in different countries. Therefore, currently available data cannot necessarily be generalized. The degree of association between breast cancer and postmenopausal HT remains controversial.
Women should be reassured that the possible risk of breast cancer associated with HT is small (less than 0.1% per
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Contact: Jean Wright
jwright.ims@btopenworld.com
International Menopause Society
16-May-2007