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

Author(s):

Panagiotis Anagnostis*, Stavroula A. Paschou, Niki Katsiki, Dimitrios Krikidis, Irene Lambrinoudaki and Dimitrios G. Goulis   Pages 1 - 9 ( 9 )

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 have 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.

Keywords:

menopausal hormone therapy, menopause, postmenopausal women, cardiovascular risk, dyslipidaemia, diabetes.

Affiliation:

Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Division of Endocrinology and Diabetes, “Aghia Sophia” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, 2nd Propedeutic Department of Internal Medicine, , 2nd Cardiology Department, , Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki



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