May 10, 1999
Web posted at: 8:29 AM EDT (1229 GMT)

In this story: How it works Who, when and how long Making the choice RELATEDS

(WebMD) -- Heart disease is the number one killer of American women, but for years the disease has been a shameful secret -- considered something that afflicts only old women but the truth is it hits some women in their 40s and 50s.

Studies show that hormone replacement therapy (HRT), a regimen of estrogen and progesterone, may help protect women from the killer, but its link to increased breast cancer risk has frightened many away from the treatment.

While HRT has been shown to speed breast cancer growth in women at increased risk of the disease, it doesn't cause it, and while one in eight women will die from breast cancer, one in three will die of heart disease.

It's time for women to reconsider their long-term health strategies based on their own risk factors and decide if HRT might be a healthy choice for them.

How it works

HRT's beneficial effects on the heart are twofold, according to Rita Redberg, M.D., a cardiologist at the University of California, San Francisco, and a member of the American Heart Association's Women and Heart Disease Task Force. Estrogen is known to reduce total cholesterol and increase HDL ("good") cholesterol, which should have a positive effect on the heart. It's also believed to have a relaxing effect on blood vessels and may help prevent hardening of the arteries.

Who, when and how long

While HRT is not the right choice for every women, it can be helpful for many as it offers the heart-protecting benefits of estrogen, which a woman stops receiving at menopause. It also relieves menopausal symptoms, prevents osteoporosis and may defend against Alzheimer's.

Women who should probably not take HRT, or should do so under very close supervision by their physician, include those with any of the following:

For those who decide postmenopausal HRT is right for them, there's no guideline as to when to start taking it.

"It's one of those situations where there's no absolute set of facts," says Wulf Utian, M.D., president of the North American Menopause Society and chairman of the department of reproductive biology at Case Western Reserve University, in Cleveland, Ohio.

Beginning at menopause seems to be the way to go. For how long remains up in the air and is a conversation each woman needs to have with her physician.

Making the choice

Before deciding if HRT is right, a women needs to talk with her doctor about her risk factors. Utian suggests she ask the following questions:

In the end it's a personal decision based on weighing the potential benefits and risks of treatment.

"There's no silver bullet," says Utian. "Nobody should look to any medication if they're not going to take the other effective steps toward healthy living. It's important women understand what this is all about and that they are calling the shots and have to be partners in their health care."

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