From discovery to debate: The history of menopausal hormone therapy and its impact on cardiovascular health

Abstract

Cardiovascular disease (CVD) continues to be the leading cause of death in women. Menopause is associated with a variety of physiological changes, including hallmark vasomotor symptoms and an increased risk of CVD. Traditional hormone therapy (HT) was the primary form of menopausal management for women until the Women's Health Initiative (WHI) trial found an increased risk of heart disease and stroke with HT use. Since the WHI publication in 2002, prescriptions for HT have plummeted and remained low, leaving menopausal women with few options for treatment and management. Although HT is very effective at treating menopausal symptoms, the data regarding cardiovascular benefits have been mixed, and reduction in CVD risk with HT may be related to the timing of initiation. The purpose of this review is to provide a clear timeline of HT usage and trials in overall support of HT as a safe and beneficial strategy for menopausal women, with an emphasis on advocacy for continued research on menopausal treatment options to improve women's health across the lifespan.