The risk of heart disease is increased in postmenopausal women, whether the menopause is natural, surgical, or premature. This increasing risk may be related to the loss of estrogens after menopause. Hormone replacement therapy (HRT) is treatment with estrogen, either alone or with another hormone called progestin. HRT may be prescribed when women experience symptoms from menopause.

A recent study examined whether postmenopausal women with CHD who take HRT experience fewer CHD events than women who have CHD and do not take HRT. The Heart and Estrogen/Progestin Replacement Study (HERS) found that:

• In the first year of the study, women receiving HRT had more CHD events than those not taking it, despite a modest drop in their LDL-cholesterol and a rise in their HDL-cholesterol levels.
• By the fourth and fifth years of the study, women in the HRT group experienced fewer events than women not taking HRT.
• Women in the HRT group experienced more blood clots and gallbladder disease.

Overall, HERS found that women taking HRT did not benefit from a lower rate of CHD events. This study looked at postmenopausal women with CHD, but the results may have implications for postmenopausal women who are trying to prevent heart disease. Postmenopausal women who are judged by their physician to need drug treatment to reduce their risk for CHD should consider cholesterol-lowering drugs instead of HRT, since cholesterol-lowering drugs have been shown to be safe and effective in lowering cholesterol and reducing CHD risk in women. HRT is useful in reducing the risks for other conditions such as osteoporosis, and should not be discontinued if already started.