Menopausal Hormone Therapy and Cardiovascular Risk: Where are we Now?

Abstract

Transition to menopause is associated with an increase in cardiovascular disease (CVD) risk, mainly attributed to lipid and glucose metabolism dysregulation, as well as to body fat redistribution, leading to abdominal obesity. Indeed, epidemiological evidence suggests that both early menopause (EM, defined as age at menopause <45 years) and premature ovarian insufficiency (POI, defined as age at menopause <40 years) are associated with 1.5-2-fold increase in CVD risk. Menopausal hormone therapy (MHT) exerts a favorable effect on CVD risk factors (with subtle differences regarding estrogen dose, route of administration, monotherapy or combination with progestogen and type of progestogen). Concerning CVD morbidity and mortality, most studies have shown a beneficial effect of MHT in women at early menopausal age [<10 years since the final menstrual period (FMP)] or younger than 60 years. MHT is strongly recommended in women with EM and POI, as these women, if left untreated, are at risk of CVD, osteoporosis, dementia, depression and premature death. MHT has also a favourable benefit/risk profile in perimenopausal and early postmenopausal women, provided that the patient is not at a high CVD risk (as assessed by 10-year calculation tools). Transdermal estrogens have a lower risk of thrombosis compared with oral regimens. Concerning progestogens, natural progesterone and dydrogesterone has a neutral effect on CVD risk factors. In any case, the decision for MHT should be individualized, tailored according to the symptoms, patient preference and the risk of CVD, thrombotic episodes and breast cancer.

Antidepressant activity of ω-3 polyunsaturated fatty acids in ovariectomized rats: role of neuroinflammation and microglial polarization

“…Depression is more frequently observed in women, and menopause is a critical predisposing factor for the psychiatric disorders. Although estrogen replacement therapy is reported effective on the mental disorder progression, there is a great concern of the side-effects of chronic estrogen treatment, such as breast cancer and cardiovascular events [20,21]. Therefore, it becomes urgent to explore the underlying mechanisms of menopause-related depression and seek an alternative treatment strategy for the mental condition.…”

The gut microbiota during the progression of atherosclerosis in the perimenopausal period shows specific compositional changes and significant correlations with circulating lipid metabolites

“…Despite existing side effects, estrogen supplementation is still the main method for treating perimenopausal syndrome. 32,33 Perimenopausal supplementation of estrogen can improve lipid metabolism 34 and inhibit AS progression [35][36][37] . We found that estrogen supplementation restored the serum lipid levels of ovariectomized ApoE −/mice to those of ApoE −/mice without receiving ovariectomy even after HFD feeding, suggesting that estrogen had a great influence on the lipid metabolism in females.…”

Oroxylin A Reduces Vasoconstriction in Rat Aortic Rings through Promoting NO Production and NOS Protein Expression via Estrogen Receptor Signal Pathway

“…e increase in cardiovascular diseases following the onset of menopause has proved that estrogen is a cardiovascular protective agent [18,19]. However, estrogen replacement therapy was reported to be related to a higher rate of endometrial cancer, breast cancer, and thromboembolic events [20]. erefore, it is important to search for a safe and effective selective regulator of ER in natural products.…”