From cardiovascular protection to cardiovascular risk: the metamorphosis of menopausal hormone therapy

Bronwyn G. A. Stuckey

doi:10.1071/RD24065

RESEARCH ARTICLE (Open Access)

Previous Contents Vol 36(10)

From cardiovascular protection to cardiovascular risk: the metamorphosis of menopausal hormone therapy

Bronwyn G. A. Stuckey

^A ^B ^C ^*

+ Author Affiliations

- Author Affiliations

^A Keogh Institute for Medical Research, Nedlands, WA 6009, Australia.

^B Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.

^C Medical School, University of Western Australia, Nedlands, WA 6009, Australia.

^* Correspondence to: bronwyn.stuckey@uwa.edu.au

Handling Editor: Jenny Juengel

Reproduction, Fertility and Development 36, RD24065 https://doi.org/10.1071/RD24065

Submitted: 26 April 2024 Accepted: 14 May 2024 Published online: 3 June 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Over the last 70 years, oestrogen therapy for the management of menopausal symptoms has undergone a metamorphosis from perceived cardiovascular protection to perceived cardiovascular risk. The former perception is based on the convincing evidence from the Nurses’ Health Study cohorts and the epidemiological data surrounding early menopause. The latter, and later, perception is based on the disquieting results from two randomised controlled studies, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative study (WHI). The reality is probably more nuanced than the conclusions presented by any of these studies. When face to face with a patient, the clinician must negotiate the appropriate decision pathway around the interaction between cardiovascular risk, cardiovascular disease, menopause, and oestrogen +/− progestogen–containing hormone therapy.

Keywords: cardiovascular disease, cardiovascular risk, causes of death, hormone replacement therapy, menopause, oestrogen, progestogen, women’s health.

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