Harvard Women's Health Watch

In brief: Hormone therapy heart benefit may depend on timing

In brief

Hormone therapy heart benefit may depend on timing

A study suggests that hormone therapy may be good for the heart after all — but only if it's initiated during a fairly narrow window of opportunity. Researchers at the Harvard Medical School analyzed data from the Nurses' Health Study, which has followed more than 120,000 female nurses since 1976. They found that women who started hormone therapy within about four years of menopause had a risk for heart disease nearly 30% lower than that of women who never used hormones. On the other hand, beginning hormone therapy 10 or more years after menopause or after age 60 showed little if any benefit. The findings were published in the January/February 2006 issue of the Journal of Women's Health.

The Harvard study, co-authored by Dr. JoAnn Manson, was undertaken to shed light on apparent discrepancies between earlier studies linking postmenopausal hormones with a reduced risk for heart disease and results from the Women's Health Initiative (WHI), which tested both an estrogen and progestin combination (Prempro) and estrogen alone (Premarin) against a placebo. The Prempro trial was halted in 2002 when it became clear that hormone users were experiencing more heart disease, stroke, and blood clots than the women taking the placebo pill. The estrogen-only trial also ended early, in 2004, because Premarin increased participants' risk for stroke without conferring any benefits for heart health.

These unanticipated findings led to considerable confusion and a sea change in clinical practice. Once widely prescribed long-term because it was thought to stave off heart problems and other age-related illnesses, hormone therapy was quickly relegated to strictly short-term treatment of symptoms such as hot flashes and vaginal dryness.

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