Discontinuing Hormone Therapy Ups Risk of Cardiovascular, Stroke Mortality

Many studies question whether the benefits of hormone therapy (HT) outweigh the risks among women experiencing menopause. While the treatment can reduce symptoms—such as hot flashes and mood changes—it is unclear whether it impacts cardiovascular health.

A new study published by Menopause suggests that HT may actually lower the risk of cardiovascular or stroke mortality, with discontinuation having the opposite effect.

Since the data from the Women’s Health Initiative were published, experts disagree about the risks and benefits of HT, according to the authors.

It is widely accepted that estrogen has beneficial vascular effects and that less time between the onset of menopause and starting HT can reduce the risk of cardiovascular disease, according to the study. The link between HT and cardiovascular protection has caused speculation that stopping HT could drastically alter cardiovascular function.

Previous studies have shown that stopping estrogen-based HT resulted in significant increases of cardiac and stroke deaths; however, the authors note that the findings may not have been accurate since women with heart disease were not excluded, which may have skewed the results.

Included in the new study were more than 400,000 Finnish women who did not experience a previous cardiovascular or stroke event.

The results suggest that discontinuing HT was linked to an increased risk of cardiac and stroke-related death during the first year, according to the study.

The authors said that the findings were especially pronounced among women younger than 60 years of age who stopped HT, but the increased risk was not observed among older women.

Overall, the findings suggest that women should not discontinue HT due to potential adverse events, but more studies are needed to confirm these results.

"Since the initial Women's Health Initiative reports, studies have shown that hormone therapy has many benefits and is safer than originally thought. This is especially true for symptomatic menopausal women younger than age 60 and within 10 years of menopause, as these women had fewer heart events and less risk of mortality," JoAnn Pinkerton, MD, executive director of the North American Menopause Society, said in a press release. "This new study suggests that younger women may have a higher risk of heart disease and stroke during the first year of discontinuation. Thus, women and their healthcare providers need to consider the benefits and risks of starting and stopping hormone therapy before making any decisions."