HRT between Risks and Benefits: Menopausal Women’s Safety

Uncover HRT between Risks and Benefits: Timing and Safety in Menopausal Women, Reducing Cardiovascular Disease Risk

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HRT, between Risks and Benefits: it's all about timing!

Menopause! The term of hot flashes, night sweats, and emotional roller coaster, we can say it’s the transition of hormonal imbalance. Amidst this chaos, one question often takes center stage: hormonal replacement therapy(HRT)- is it safe? It is just like stepping onto a rickety theme park ride. should you ride or run?

This is what we will discuss here, HRT between Risks and benefits!


Cardiovascular Disease: The Leading Killer of Women

Before we climb aboard the HRT train, let’s learn about cardiovascular disease (CVD)…

CVD holds the dubious title of women’s leading killer, silently creeping up with alarming prevalence. But why are women particularly vulnerable?

Enter menopause means estrogen levels are decreased, our arteries stiffen, cholesterol levels rise, and inflammation becomes our unwanted party guest. All of these factors sadly increase the risk of heart attacks and strokes.

Early research painted a gloomy picture, suggesting an increased risk of death from CVD with some forms of non BioIdentical Hormonal therapy. But like a master mechanic, science fine-tuned the approach. Newer studies, like the WHI, revealed that the type, dosage, and timing of HRT 7play crucial roles.

For women with existing CVD or at high risk, individualization is key.


prevalence and impact of CVD in women:

Do you know? Due to cardiovascular diseases(CVD), there is approximately one death every 80 seconds! Causing 1 in 3.2 deaths in women each year in the U.S.,

I was really surprised when I found out that the incidence of coronary heart disease (CHD) in women lags behind men by 10 years, And the incidence of myocardial infarction (MI) and sudden death in women lags behind men by 20 years!

This delay in the onset of CVD appears to be due to cardioprotective effects of endogenous estrogen… Women exhibit two patterns of cardiovascular disease risk during their lifespan, perimenopause and after menopause.

While premenopausal, women are protected by endogenous estrogen from manifestations of CVD relative to men, after menopause CVD exceeds those of men. Also, age-specific CVD incidence is two to sixfold greater for postmenopausal than premenopausal.

This is where the role of hormonal replacement therapy is broken out! Endogenous hormonal therapy is the key…

So, Let’s learn more about HRT and Cardiovascular diseases,,,


First of all, do you think there is a Role of Hormonal replacement Therapy in coronary heart disease (CHD)?

According to WHI (Women Health Initiative), more than 40 observational studies show a consistent (30% – 50%) reduction in CHD in HRT users versus nonusers.

In random clinical trials(RCTs) the effect of HRT on CHD may be null, but these trials also show that these are beneficial effects of HRT on CHD according to the timing of initiation of HRT relative to age and\or menopause.

The timing hypothesis posits that The effect of menopausal HRT On cardiovascular events Depends upon when HRT Is Initiated about age and/or menopause.

Over the last 20 years, there has been substantial cumulation of RCT data that strongly support this timing hypothesis.

In two meta-analyses, data showed that HRT significantly reduced all-cause mortality by 39% across 30 RCTs. And reduced CHD by 32% across 23 RCTs when initiated in women <60 years of age and\or >10 years since menopause.


New Guidelines for Hormone Therapy in Menopausal Women:

It’s amazing to know that when HRT is initiated in women <60 years of old or <10 years since menopause, it significantly reduces all-cause mortalities and coronary heart diseases with a percentage of (30%-50%).

Yes, Recent guidelines already showed and confirmed that hormonal replacement therapy has a high positive effect on primary prevention from CVD in women, rather than men, whereas other cardioprotective therapies like; (lipid-lowering agents and aspirin) have null effects in primary prevention!

Studies also showed that lipid-lowering agents work for secondary prevention from CVD, But when it comes to primary prevention HRT surpasses..

To be more familiar with what I mean, primary prevention aims to avoid disease entirely before it occurs, to decrease the risk of disease occurring! Where in secondary prevention the disease already occurred, it aims to detect the disease early and prevent manifestations.

So for CVD prevalence in women, when we say “prevention is better than cure” we must mention the role of HRT ( hormonal replacement therapy).


Risks and Benefits of HRT:

Fortunately, HRT has rare side effects, especially when initiated in women under the age of 60 years or 10 years close to menopause!

Yes, according to WHI trials on benefits of HRT relative to placebo, it is shown that “Risks of HRT are small and rare”.

You may ask now! What about cancer? What about diabetes mellitus? Let’s see,,


HRT and cancer:

In fact, three meta-analyses showed that the non- hormonal medications for CVD prevention are associated with breast cancer risk! ( for example; the incidence of breast cancer was 9%-33% greater with statin therapy than with placebo..

On the other hand, there is a study ( according to National Cancer Institute) showed that, women who received HRT after diagnosis of ovarian cancer lived longer than women who didn’t receive HRT! In addition to other health benefits beyond the relief of menopasal symptoms for women diagnosed with ovarian cancer.

To be more accurate, the study authors wrote by the text “These results show that women who have severe menopausal symptoms after ovarian cancer treatment can safely take hormone replacement therapy, and this may, in fact, infer benefits in terms of overall survival in addition to known advantages in terms of quality of life “.


HRT and diabetes mellitus:

the morbidity associated with diabetes is greater for women than for men! Although it is still unclear whether menopause is a cause of diabetes mellitus or not, But what is clear is that when women enter menopause, many metabolic and biochemical changes are already related and increase the risk of diabetes.

Since aging and menopausal women have the risk for insulin resistance, glucose intolerance, and new-onset diabetes mellitus,, Here is the role of HRT…

HRT improves insulin resistance, increases glucose tolerance, and reduces new- onset diabetes mellitus by 20-30%!

Remember, the risks and benefits of any medication, especially personalized ones vary depending on individual factors like age, medical history, and family history. There is no “one size fits all” So it is crucial to discuss benefits and risks with a healthcare professional who can assess your individual needs and situation.

You can communicate Welltopia   to get one on one consultation with the all profession and confidentiality you need.

In conclusion, HRT is a sex-specific and time-dependent primary CVD preventive therapy that reduces all-cause mortality as well as a diversity of other related diseases with an excellent risk profile (approximately null).

Fortunately, Data not only provide strong evidence for the beneficial effects of menopausal HRT, But also a reassurance of long-term safety. So it is time to recognize that HRT reduces all-cause mortality and CVD. It’s all about timing!



1. What is Menopausal Hormone Replacement Therapy (HRT)?

Is a group of preparations with sex hormones that are administered to offset low estrogen levels and reduce symptoms related to menopause, it may be estrogen-only therapy (ET) or combined with progesterone(EPT). Prepared individually by compounded pharmacy according to the stage of menopause.

You can communicate Welltopia compounding pharmacy to know more about HRT.


2. How does HRT impact the risk of cardiovascular disease in menopausal women?

When endogenous estrogen in premenopausal women is shown to be a protective agent against CVD, Hence exogenous estrogen may help for postmenopausal.


3. Is HRT safe for all menopausal women?

HRT is an individualized medication. Safety and benefits are determined according to your needs, dosage, and stage of menopause. You can consult a healthcare provider about your situation. WELLTOPIA CONSULTAION.


4. What are the benefits of HRT aside from cardiovascular health?

HRT effectively helps such conditions as hot flashes, vaginal dryness, night sweats, and bone loss. These benefits can lead to improved sleep, sexual relations, and quality of life.


5. Are there any risks associated with HRT?

Risks of HRT are rare and small according to WHI.



  1. Hormone Replacement Therapy May Improve Survival for Women with Ovarian Cancer

  2. Menopause hormone therapy: latest developments and clinical practice



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