Risk Factors Specific to Women

April 17, 2023 at 2:23 pm

This week in our A Guide to a Healthy Heart series we will continue talking about other risk factors for heart disease. There are some factors that are specific to women and hormone usage, both for menopause and for birth control.

Menopausal Hormone Therapy

Menopausal hormone therapy was once thought to help ward off heart disease, osteoporosis, and cancer. Several important studies conducted as part of the Women’s Health Initiative show that not to be true. The studies show that long-term use of hormone therapy poses serious health risks, including increased risks of heart attack, stroke, and a condition called venous thrombosis (a blood clot that usually occurs in the deep veins of the leg).

One of the studies conducted involved over 16,000 postmenopausal women with a uterus took either estrogen plus progestin therapy or a placebo. The estrogen plus progestin therapy actually increased women’s risk for heart attacks, stroke, blood clots, and breast cancer. A related study showed that there was double the risk of dementia with the hormone combination. The estrogen plus progestin regiment did reduce the risk of colorectal cancer and bone fractures. Hot flashes and night sweats were also relieved.

Another study used over 10,000 women who had had a hysterectomy and took either estrogen alone or a placebo. This study showed increased risks for stroke and venous thrombosis. The treatment had no effect on heart disease or colorectal cancer. The effect on breast cancer was uncertain. Estrogen alone offered no protection against memory loss; it did however reduce the risk for bone fractures.

The studies showed that both estrogen alone and estrogen combined with progestin increased the risk of urinary incontinence. For women who already had this condition the medication made the symptoms worse.

If you are a woman who is taking menopausal hormone therapy, or if you’ve used it in the past, these findings can’t help but concern you. It’s important to understand, however, that the results apply to a very large group of women. For an individual woman, the increased risk for disease is quite small. For example, in the estrogen-plus-progestin study, each woman had an increased risk of breast cancer of less than one-tenth of 1 percent per year. While questions remain, these findings provide a basis for advice about using hormone therapy:

Estrogen alone, or estrogen-plus-progestin, should not be used to prevent heart disease. Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.
If you are considering using menopausal hormone therapy to prevent the bone-thinning disease osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer. Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.
Do not take menopausal hormone therapy to prevent dementia or memory loss.
If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you. The studies did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms. The U.S. Food and Drug Administration recommends that menopausal hormone therapy be used at the lowest dose for the shortest period of time to reach treatment goals.

Birth Control Pills

Studies show that women who use high-dose birth control pills (oral contraceptives) are more likely to have a heart attack or stroke because blood clots are more likely to form in the blood vessels. These risks are lessened once the birth control pill is stopped. Using the pill also may worsen the effects of other risk factors, such as smoking, high blood pressure, diabetes, high blood cholesterol, and overweight.

Much of this information comes from studies of birth control pills containing higher doses of hormones than those commonly used today. Still, the risks of using low-dose pills are not fully known. Therefore, if you are now taking any kind of birth control pill or are considering using one, keep these guidelines in mind:

Don’t mix smoking and the “pill”

If you smoke cigarettes, stop smoking or choose a different form of birth control. Cigarette smoking raises the risk of serious health problems from birth control pill use, especially the risk of blood clots. For women over 35, the risk is particularly high. Women who use birth control pills should not smoke.

Pay attention to diabetes

Levels of glucose, or blood sugar, sometimes change dramatically in women who take birth control pills. If you are diabetic or have a close relative who is, be sure to have regular blood sugar tests if you take birth control pills.

Watch your blood pressure.

After starting to take birth control pills, your blood pressure may go up. If your blood pressure increases to 140/90 mmHg or higher, ask your doctor about changing pills or
switching to another form of birth control. Be sure to get your blood pressure checked at least once a year.

Talk with your doctor. If you have heart disease or another heart problem, or if you have suffered a stroke, birth control pills may not be a safe choice. Be sure your doctor knows about these and any other serious health conditions before prescribing birth control pills for you.

If you are a woman, talk with your doctor about risk factors that may be specific to you.

Dr. Bobish

Dr. Bobish and her team’s goal is to help you reduce your risk of heart disease. Helping you to understand your risk factors and make healthful lifestyle changes.

Remember regardless of age or current state of health it is never too late to start protecting your heart. It is also never too soon and the sooner you act the better. Follow us on Facebook to see our latest post helping to keep you heart healthy. You can also explore all our articles that offer diet and exercise tips, recipes and information on procedures and heart disease.

Dr. Bobish and her team focus on preventative care and are here to support you. Alpine Cardiology provides patients with education as well as compassionate care and treatment. We are committed to keeping you healthy and heart smart! Request an appointment at 989-448-7002

Guide to a Healthy Heart

We are committed to keeping Northern Michigan healthy and heart-smart!

Over the next several months we will be publishing a series of articles that will become A Guide to a Healthy Heart. By breaking these guidelines into chapters we are able to offer more in depth information on the topics. Watch our Facebook page or website for the latest article.

Alpine Cardiology’s goal is to give you a better understanding of how to live a healthy lifestyle and to take care of your heart. To take the mystery out of what the tests are and what they mean. To encourage you to talk to your healthcare provider about your risk factors and how to reduce your risk. The more you know and understand the more likely you are to be successful in reducing risk and having a healthier lifestyle.

Links to published chapters are below if you would like to explore the guide more.