HRT Safety

Great information from everyone. One question. Assuming a woman 15 yrs post menopause is in the low to intermediate risk category and goes on hrt. Is she on hormones for the rest of her life? or tested every year to determine when to come off? When she stops hrt does she go through the same symptoms as menopause?

Great information from everyone. One question. Assuming a woman 15 yrs post menopause is in the low to intermediate risk category and goes on hrt. Is she on hormones for the rest of her life? or tested every year to determine when to come off? When she stops hrt does she go through the same symptoms as menopause?

I've been thinking about this for awhile. One of my obgyns who uses hrt herself did tell me that the use will be for the rest of life unless problem(s) arises. Like @teb pointed out, there are periodic tests/exams and labs need to be done to assess ongoing risks vs benefits. As far as the reoccurence of menopause symptoms after cessation of hrt, my hunch is it will be inevitable, but the magnitude of which is questionable. The estrogen receptors are largely downregulated 10-15 years post menopause, even they get upregulated again by HRT, the biological effects of estrogen won't be as robust as when we were young. If you didn't have troublesome vasomotor symptoms last time, I think its unlikely you'd have worse experiences the second time around. But, all these thoughts are just thoughts. In the event when you are off hrt, you'd definitely follow up with a bisphosphonate or better yet, an anabolic.

Beside the multiple advantages of taking HRT in perimenopause is bone protection sufficient with HRT alone.

Hi @debbie1956 thank you very much for posting this podcast link. It summarizes the current view/approaches well, especially for those of us who are 10 years past menopause. The “timing hypothesis” has been discussed here and there are published papers available on this topic.

Regarding cardiovascular risk related to HRT use, there is an article I came across by Cleveland Clinic worth reading:
https://consultqd.clevelandclinic.org/menopausal-hormone-therapy-and-heart-risk-updated-guidance-is-at-hand
In this article, the risks were stratified to 3 categories:

“In keeping with the guidelines from the four medical societies, the ACC committee advises cardiologists to take a risk-stratified approach to HT, as follows:

Treatment is low-risk in women with recent menopause, normal weight and normal blood pressure who are physically active and have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 5% as well as a low risk for breast cancer.
Treatment is intermediate-risk in women who have one or more of several risk factors (diabetes, smoking, hypertension, obesity, sedentary lifestyle or limited mobility, autoimmune disease, hyperlipidemia, metabolic syndrome) and those who have a 10-year ASCVD risk from 5% to 10% or are at high risk for breast cancer.
Treatment is high-risk in women who have congenital heart disease, ASCVD or coronary/peripheral artery disease, venous thromboembolism (VTE) or pulmonary embolism, stroke/transient ischemic attack or myocardial infarction, breast cancer or a 10-year ASCVD risk ≥ 10%.”

The article also provided a link for an in depth review by Dr. Leslie Cho, a Cleveland clinic cardiologist.

I was under the care of my current cardiologist for 3 years then sought a second opinion of a cardiologist who specializes women’s heart recently. They both concluded that HRT is suitable for me as far as cvd risk is considered, even though I had a cac score of 38. I had numerous tests done and labs are followed closely for the past 3 years. The cardiology specialist wanted the target for my LDL-c below 55 and HbA1c below 5.6, a stricter target than the one I previously followed. Now looking at the stratified category, I realize I’m between low and intermediate risk. Maybe that’s why the specialist adjusted target bio parameters lower.

Hope this article is helpful to someone seeking cvd risk related information.

Wish you a smooth process going forward, and that HRT works for your needs!

I've been thinking about this for awhile. One of my obgyns who uses hrt herself did tell me that the use will be for the rest of life unless problem(s) arises. Like @teb pointed out, there are periodic tests/exams and labs need to be done to assess ongoing risks vs benefits. As far as the reoccurence of menopause symptoms after cessation of hrt, my hunch is it will be inevitable, but the magnitude of which is questionable. The estrogen receptors are largely downregulated 10-15 years post menopause, even they get upregulated again by HRT, the biological effects of estrogen won't be as robust as when we were young. If you didn't have troublesome vasomotor symptoms last time, I think its unlikely you'd have worse experiences the second time around. But, all these thoughts are just thoughts. In the event when you are off hrt, you'd definitely follow up with a bisphosphonate or better yet, an anabolic.

I've been thinking about this for awhile. One of my obgyns who uses hrt herself did tell me that the use will be for the rest of life unless problem(s) arises. Like @teb pointed out, there are periodic tests/exams and labs need to be done to assess ongoing risks vs benefits. As far as the reoccurence of menopause symptoms after cessation of hrt, my hunch is it will be inevitable, but the magnitude of which is questionable. The estrogen receptors are largely downregulated 10-15 years post menopause, even they get upregulated again by HRT, the biological effects of estrogen won't be as robust as when we were young. If you didn't have troublesome vasomotor symptoms last time, I think its unlikely you'd have worse experiences the second time around. But, all these thoughts are just thoughts. In the event when you are off hrt, you'd definitely follow up with a bisphosphonate or better yet, an anabolic.

Hi @debbie1956 thank you very much for posting this podcast link. It summarizes the current view/approaches well, especially for those of us who are 10 years past menopause. The “timing hypothesis” has been discussed here and there are published papers available on this topic.

Regarding cardiovascular risk related to HRT use, there is an article I came across by Cleveland Clinic worth reading:
https://consultqd.clevelandclinic.org/menopausal-hormone-therapy-and-heart-risk-updated-guidance-is-at-hand
In this article, the risks were stratified to 3 categories:

“In keeping with the guidelines from the four medical societies, the ACC committee advises cardiologists to take a risk-stratified approach to HT, as follows:

Treatment is low-risk in women with recent menopause, normal weight and normal blood pressure who are physically active and have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 5% as well as a low risk for breast cancer.
Treatment is intermediate-risk in women who have one or more of several risk factors (diabetes, smoking, hypertension, obesity, sedentary lifestyle or limited mobility, autoimmune disease, hyperlipidemia, metabolic syndrome) and those who have a 10-year ASCVD risk from 5% to 10% or are at high risk for breast cancer.
Treatment is high-risk in women who have congenital heart disease, ASCVD or coronary/peripheral artery disease, venous thromboembolism (VTE) or pulmonary embolism, stroke/transient ischemic attack or myocardial infarction, breast cancer or a 10-year ASCVD risk ≥ 10%.”

The article also provided a link for an in depth review by Dr. Leslie Cho, a Cleveland clinic cardiologist.

I was under the care of my current cardiologist for 3 years then sought a second opinion of a cardiologist who specializes women’s heart recently. They both concluded that HRT is suitable for me as far as cvd risk is considered, even though I had a cac score of 38. I had numerous tests done and labs are followed closely for the past 3 years. The cardiology specialist wanted the target for my LDL-c below 55 and HbA1c below 5.6, a stricter target than the one I previously followed. Now looking at the stratified category, I realize I’m between low and intermediate risk. Maybe that’s why the specialist adjusted target bio parameters lower.

Hope this article is helpful to someone seeking cvd risk related information.

Wish you a smooth process going forward, and that HRT works for your needs!

@mayblin The Cleveland Clinic article was very helpful and much appreciated thank you. I found it reassuring and like that it goes into detail. I was very happy with the menopause practitioner I consulted last week who had an impressive knowledge of OP and HT. The Cleveland article substantiates her qualifications and information she provided. My cardiovascular and diabetic risk was the main focus of her risk assessment. It would appear I may be between a level 1 and 2 risk as well with a rare autoimmune condition (no symptoms now) I receive IVIG for. The LDL level of below 55 your cardiologist is aiming for seems below the Canadian lower reference range when I do the conversion. Perhaps I have the wrong formula. My numbers are all fine fortunately. How I wish I had started the HT 10 years ago, butI 'm hopeful the Estradiol patch and micronized progesterone I began yesterday will prevent further bone loss and preserve quality. No symptoms at all so far and I am extremely sensitive to medication. Are you presently on HT?

I wish you much success in your journey ahead as well!