EMAS position statement: Managing the menopause in the context of coronary heart disease

Area of Science:

• Cardiology
• Endocrinology
• Women's Health

Background:

• Cardiovascular disease (CVD) is the leading cause of death in women, with incidence rising significantly after menopause.
• Coronary heart disease (CHD) presents a decade later in women than men, potentially due to estrogen's protective effects.
• Menopause marks a critical transition for cardiovascular risk in women.

Purpose of the Study:

• To establish a position statement on managing menopausal women concerning coronary heart disease.
• To provide guidance on hormone therapy (HT) use in postmenopausal women with cardiovascular considerations.

Main Methods:

• Comprehensive literature review.
• Consensus development among expert opinion.

Main Results:

• Long-term randomized, placebo-controlled studies do not support hormone therapy (HT) for primary or secondary prevention of CHD in postmenopausal women.
• The primary indication for HT remains the management of menopausal symptoms.
• Individualized risk assessment for breast cancer, venous thromboembolism (VTE), and CHD recurrence is crucial for women with existing CVD or risk factors considering HT.

Conclusions:

• HT is not recommended for CHD prevention in postmenopausal women.
• When HT is considered for severe menopausal symptoms in women with CVD risk factors, risks (breast cancer, VTE, CHD recurrence) must be weighed against benefits (symptom relief, quality of life).
• Lowest effective estrogen doses for the shortest duration are advised, with transdermal routes preferred if VTE risk factors are present. Certain progestogens like micronized progesterone or dydrogesterone may offer a better thrombotic risk profile.