Number of women needed in a prospective trial to prove potential cardiovascular benefit of hormone replacement therapy

Confronting the challenges of the menopausal transition

Canada’s Generation X is now entering the menopausal transition and pursuing effective therapy for bothersome vasomotor symptoms. They do so at a time when confusion about the safe and appropriate use of menopausal hormone therapy (MHT) has never been greater. Misplaced fears among women and their health care providers about MHT have, in many circumstances, led them to abandon this most effective therapy. This review discusses the physiology of the menopausal transition, the nature of symptoms related to withdrawal of ovarian estrogen production, and the potential benefits and risks of MHT. It is now clear that for most recently menopausal women the benefits of MHT outweigh the risks. The rationale for choosing different dosages, formulations, and regimens is reviewed.

The effects of hormone replacement therapy on myocardial performance in early postmenopausal women

OBJECTIVES

The results of the studies in which the effect of hormone replacement therapy (HRT) on cardiac function have been evaluated are rather disputable. In these studies, cardiac function was evaluated with conventional echocardiographic methods. This study was planned in order to investigate the effects of HRT on myocardial velocities and myocardial performance index (MPI) in healthy early postmenopausal women.

METHOD

In a prospective, controlled study, 60 healthy postmenopausal women were assigned to two groups (32 in the HRT group and 28 in the control group). After conventional echocardiographic parameters were measured, tissue Doppler echocardiography recordings were obtained from the mitral and tricuspid annulus. Systolic myocardial velocity (Sm), early and late diastolic myocardial velocities (Em and Am) and time intervals were measured and MPI was calculated. Then the symptom-limited exercise stress test using the Bruce protocol was performed. After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone acetate/day), the same examinations were repeated. The effects of HRT on myocardial velocities, MPI and exercise time were evaluated at the 3rd and 6th months.

RESULTS

The parameters of the control group remained statistically unchanged during the study. HRT did not have any effect on segmental and mean left ventricular (LV) Sm or right ventricular (RV) Sm. However, LV Em/Am and RV Em/Am ratios significantly increased at the 6th month of HRT, and LV and RV MPI values were observed to decrease significantly as compared to basal values. Additionally, a significant increase was observed in exercise duration and metabolic equivalent values after 3 months of HRT, and this increase continued at the 6th month as well. The favorable changes in all parameters in the HRT group were significantly different from those of the control group.

CONCLUSION

Data obtained in this study suggest that HRT is not only effective for treating menopausal complaints but also increases cardiovascular performance by improving especially diastolic functions in early postmenopausal women.

Postmenopausal hormone therapy and the risk of cardiovascular disease

BACKGROUND

Risks and benefits of postmenopausal hormone therapy remain highly controversial. After publication of the Women's Health Initiative hormone trials and several other major trials, the American Heart Association designated postmenopausal hormone therapy as 'Class III', if initiated for the purpose of cardiovascular disease prevention. Subsequent post hoc analyses of the Women's Health Initiative data have renewed enthusiasm for hormone therapy among younger postmenopausal women.

OBJECTIVE

To review data from randomized clinical trials that have assessed cardiovascular outcomes of hormone therapy including coronary heart disease, stroke, peripheral arterial disease, and venous thromboembolism.

METHODS

The review focuses on cardiovascular effects of hormone therapy only and does not attempt to integrate potential risks and benefits related to symptoms, cancer, osteoporosis or other noncardiovascular effects of postmenopausal hormone therapy. The literature search included original trial publications, post hoc analyses, and aggregate data from meta-analyses published in English and accessible to the author in full-text format for detailed analysis.

RESULTS/CONCLUSION

Risks of hormone therapy seem to predominate among older postmenopausal women. Data among younger women close to menopause are insufficient to recommend such therapy for cardiovascular disease prevention.