Skip to main content

Cardiovascular Prevention at the Menopausal Transition: Role of Hormonal Therapies

  • Chapter
Frontiers in Gynecological Endocrinology

Part of the book series: ISGE Series ((ISGE))

  • 1143 Accesses

Abstract

Cardiovascular disease (CVD) has become the leading cause of death for women. The incidence of CVD in women increases substantially with aging, probably because menopause diminishes the gender protection contributing to an adverse impact on cardiovascular risk variables. In this setting, the menopausal transition (MT) must be considered a critical period in women’s life because it leads to several adverse changes, especially with regard to lipid profile and modifies cardiovascular risk factors. Thus, it may be necessary to encourage lifestyle measures and therapeutic interventions such as hormone replacement therapy (HRT) throughout the MT to counteract or prevent these events. HRT for postmenopausal women has been available for more than 60 years. Ever since, HRT has been the subject of discussion and debate regarding its safety and efficacy; nowadays, it is well established that timing in the initiation as well as the type, dose and route of HRT are crucial for the success and benefit of HRT. Furthermore, a new study, published by the British Medical Journal, recently added interesting evidence to this debate, proving that menopausal hormone therapy saves lives and reduces disability.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 64.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW et al (2012) Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab 97(4):1159–1168

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Wang Q, Hassager C, Ravn P, Wang S, Christiansen C (1994) Total and regional body-composition changes in early postmenopausal women: age-related or menopause-related? Am J Clin Nutr 60(6):843–848

    CAS  PubMed  Google Scholar 

  3. Sternfeld B, Dugan S (2011) Physical activity and health during the menopausal transition. Obstet Gynecol Clin North Am 38(3):537–566

    Article  PubMed Central  PubMed  Google Scholar 

  4. Toth MJ, Tchernof A, Sites CK, Poehlman ET (2000) Menopause-related changes in body fat distribution. Ann N Y Acad Sci 904:502–506

    Article  CAS  PubMed  Google Scholar 

  5. Toth MJ, Tchernof A, Sites CK, Poehlman ET (2000) Effect of menopausal status on body composition and abdominal fat distribution. Int J Obes Relat Metab Disord 24(2):226–231

    Article  CAS  PubMed  Google Scholar 

  6. Simkin-Silverman LR, Wing RR (2000) Weight gain during menopause. Is it inevitable or can it be prevented? Postgrad Med 108(3):47–50

    Article  CAS  PubMed  Google Scholar 

  7. Mendelsohn ME, Karas RH (1999) The protective effects of estrogen on the cardiovascular system. N Engl J Med 340(23):1801–1811

    Article  CAS  PubMed  Google Scholar 

  8. Fu XD, Simoncini T (2007) Non-genomic sex steroid actions in the vascular system. Semin Reprod Med 25(3):178–186

    Article  CAS  PubMed  Google Scholar 

  9. Simoncini T, Genazzani AR (2003) Non-genomic actions of sex steroid hormones. Eur J Endocrinol 148(3):281–292

    Article  CAS  PubMed  Google Scholar 

  10. Simoncini T, Mannella P, Fornari L, Caruso A, Varone G, Genazzani AR (2004) Genomic and non-genomic effects of estrogens on endothelial cells. Steroids 69(8–9):537–542

    Article  CAS  PubMed  Google Scholar 

  11. Simoncini T (2009) Mechanisms of action of estrogen receptors in vascular cells: relevance for menopause and aging. Climacteric 12(Suppl 1):6–11

    Article  CAS  PubMed  Google Scholar 

  12. Lerner DJ, Kannel WB (1986) Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 111(2):383–390

    Article  CAS  PubMed  Google Scholar 

  13. Tracy RE (1966) Sex difference in coronary disease: two opposing views. J Chronic Dis 19(11):1245–1251

    Article  CAS  PubMed  Google Scholar 

  14. Tunstall-Pedoe H (1998) Myth and paradox of coronary risk and the menopause. Lancet 351(9113):1425–1427

    Article  CAS  PubMed  Google Scholar 

  15. Santoro N, Sutton-Tyrrell K (2011) The SWAN song: Study of Women’s Health Across the Nation’s recurring themes. Obstet Gynecol Clin North Am 38(3):417–423

    Article  PubMed Central  PubMed  Google Scholar 

  16. Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B et al (2009) Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol 54(25):2366–2373

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B et al (1992) Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 117(12):1016–1037

    Article  CAS  PubMed  Google Scholar 

  18. Henderson BE, Paganini-Hill A, Ross RK (1991) Decreased mortality in users of estrogen replacement therapy. Arch Intern Med 151(1):75–78

    Article  CAS  PubMed  Google Scholar 

  19. Guidelines for counseling postmenopausal women about preventive hormone therapy. American College of Physicians (1992). http://www.ncbi.nlm.nih.gov/pubmed/1443972. Ann Intern Med 117(12):1038–1041

  20. Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ (1999) Use of hormone replacement therapy by postmenopausal women in the United States. Ann Intern Med 130(7):545–553

    Article  CAS  PubMed  Google Scholar 

  21. Yager JD, Davidson NE (2006) Estrogen carcinogenesis in breast cancer. N Engl J Med 354(3):270–282

    Article  CAS  PubMed  Google Scholar 

  22. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL et al (2003) Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 349(6):523–534

    Article  CAS  PubMed  Google Scholar 

  23. Haas JS, Kaplan CP, Gerstenberger EP, Kerlikowske K (2004) Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results. Ann Intern Med 140(3):184–188

    Article  PubMed  Google Scholar 

  24. Gass ML, Heights M, Manson JE, Cosman F, Hayes H, Grodstein F, et al (2012) North American Menopause Society. The 2012 hormone therapy position statement of: the North American Menopause Society. http://www.ncbi.nlm.nih.gov/pubmed/22367731. Menopause 19(3):257–271

  25. Ghazal S, Pal L (2013) Perspective on hormone therapy 10 years after the WHI. Maturitas 76(3):208–212

    Article  PubMed  Google Scholar 

  26. Hodis HN, Mack WJ (2011) A “window of opportunity:” the reduction of coronary heart disease and total mortality with menopausal therapies is age- and time-dependent. Brain Res 1379:244–252

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Genazzani AR, Simoncini T (2007) Timing is everything. Gynecol Endocrinol 23(1):1–4

    Article  PubMed  Google Scholar 

  28. Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD et al (2010) Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab 95(7 Suppl 1):s1–s66

    Article  CAS  PubMed  Google Scholar 

  29. Smiley DA, Khalil RA (2009) Estrogenic compounds, estrogen receptors and vascular cell signaling in the aging blood vessels. Curr Med Chem 16(15):1863–1887

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Khalil RA (2013) Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease. Biochem Pharmacol 86(12):1627–1642

    Article  CAS  PubMed  Google Scholar 

  31. Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L et al (2012) Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 345:e6409

    Article  PubMed  Google Scholar 

  32. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288(3):321–333

    Article  CAS  PubMed  Google Scholar 

  33. Moyer VA (2013) Menopausal hormone therapy for the primary prevention of chronic conditions: U.S. Preventive services task force recommendation statement. Ann Intern Med 158:47–54

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tommaso Simoncini .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 International Society of Gynecological Endocrinology

About this chapter

Cite this chapter

Spina, S., Bernacchi, G., Cecchi, E., Genazzani, A.R., Simoncini, T. (2015). Cardiovascular Prevention at the Menopausal Transition: Role of Hormonal Therapies. In: Fauser, B.C.J.M., Genazzani, A.R. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-09662-9_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09662-9_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09661-2

  • Online ISBN: 978-3-319-09662-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics