Menopause is an inevitable process that all women must undergo. For centuries different variations of administering hormones to suppress the symptoms can be seen. Hormone replacement is perhaps the most common remedy to counter the menopause-linked symptoms and hence researchers at the University of Pittsburgh Graduate School of Public Health were investigating ways in which the therapy can be made safer and more effective.
In a rather interesting reveal, the study concluded that there is a need to tailor the therapy according to the type of case at hand. Factors like the risk of contracting different diseases and the hormonal and bodily response to the therapy had to be taken into account.
The findings from the study are published in the science journal, the Journal of the American Heart Association. The research team conducted tests to investigate the effect the therapy was having on the fat storage across the body. Prior tests had shown that the patients who had undergone therapy had developed fat deposits especially in and around the heart.
The study helped in understanding that the method of hormonal intake mattered as those women who took the hormones as a pill showed different fat deposits than the ones that placed a patch on the skin. But either way, the arteries get hardened and the risk of cardiovascular disease was significantly increased.
Dr. Samar El Khoudary, an associate professor at the University of Pittsburgh, commented on the issue, “We cannot treat all menopause hormone therapy types the same,”. Mr. Khoudary specializes in epidemiology and is the lead author of the study. “We’re adding to the recognized list of cardiovascular-related effects of menopause hormone therapy by showing a novel cardiovascular risk factor that’s specific to menopausal women also is affected by hormone therapy.”
Menopause is not exactly a smooth affair for women, it comes coupled with dryness of the genitals, sweating while sleeping and an elevated risk of osteoporosis.
The team ran their tests on around 450 women aged between 42 and 58. Kronos Early Estrogen Prevention Study (KEEPS) is a study involving a multi-center, randomized, placebo-controlled clinical trial of the effects of oral conjugated equine estrogens and transdermal 17-beta-estradiol on atherosclerosis progression and the women who participated in the study were a part of the KEEPS study as well. Tabs were kept on the patients for more than 4 years to analyze the effects.
“The KEEPS trial is unique because it focuses on younger women close to the onset of menopause, and tested both a pill and patch formulation of menopausal hormone therapy,” said Ms. JoAnn E. Manson a physician at Brigham and Women’s Hospital. Ms. Manson also serves as professor of epidemiology at the Harvard Medical School. “This allowed us to see the effects of different types of hormone therapy and whether the route of delivery—oral or through the skin—affected heart health in otherwise healthy women.”
The team had conducted studies before the current one and Khoudary’s team concluded that postmenopausal women with a lower level of estrogen serum had greater deposits of fats around and outside the pericardium. Coronary artery calcification was also high as compared to women who had not entered their menopause.
The hormone therapy type and the mode of administration played pivotal roles in the deposits.
The transdermal estradiol patch (the patch applied to the skin) proved to be more harmful as the paracardial fats elevated the coronary artery calcification.
Oral administration of hormones exhibited lesser increases in fats around the heart and the coronary artery calcification was not that worsened.
“That was surprising,” El Khoudary said. “The patch is thought to be safer because it’s not systemic, just topical, and it doesn’t have an impact on inflammation or triglyceride levels like oral hormones.”
“Many clinical guidelines recommend consideration of transdermal estradiol as a first-line treatment for hormone therapy because it is associated with less risk for blood clot events compared to oral conjugated estrogen,” said study co-author Nanette Santoro. Santoro is a renowned professor of obstetrics and gynecology at the University of Colorado, Denver.
“This study makes us think twice about that recommendation and reminds us that there is more complexity to the story of how or whether menopausal hormones protect women against heart disease later in life or increase their risk.”
Though the team has ample evidence to support their opinion Ms. Khoudary has warned against generalizing about oral versus transdermal hormone delivery. She is hopeful that these findings will assist doctors in making better decisions while treating menopause.