Influence of hormone therapy on cardiovascular health in postmenopausal women

Authors

DOI:

https://doi.org/10.55892/jrg.v9i20.2960

Keywords:

cardiovascular diseases, menopause, hormone replacement therapy

Abstract

Cardiovascular disease (CVD) is the leading cause of death in women, with a higher risk after menopause due to the drop in estradiol (E2) levels. Therefore, Hormone Replacement Therapy (HRT) has emerged as an alternative to reduce CVD mortality. The objective of this article is to analyze the effects of HRT on the cardiovascular health of postmenopausal women, considering the benefits and risks in CVD prevention. An integrative literature review was conducted, analyzing 386 articles extracted from the PubMed and BVS databases using the descriptors "hormone replacement therapy," "cardiovascular diseases," and "menopause." Original studies in English, published between 2020 and 2025, with free access, were included, excluding duplicate, incomplete, or unrelated articles. Thus, 22 articles were analyzed regarding the efficacy and risks associated with HRT. The review indicated that the use of HRT in menopause presents complexities, especially regarding cardiovascular risk. Although it can improve quality of life and prevent cardiac events by reducing LDL cholesterol and insulin resistance, there are also risks related to specific outcomes, such as venous thromboembolism (VTE). Furthermore, the effects on blood pressure remain controversial. Age is a crucial factor, with proven benefits in women under 60, reducing the risk of acute coronary heart disease by 44%; however, recent evidence indicates that specific formulations may also benefit women above this age. The transdermal route has proven preferable, with fewer adverse effects. Therefore, HRT can provide cardiovascular benefits, especially when initiated early, but it is not recommended as a primary prevention strategy. The decision should be individualized, considering each patient's factors, to optimize benefits and minimize risks. More studies are needed to clarify these variables.

Downloads

Download data is not yet available.

Author Biographies

Laís Kethleen Martins Santos, Universidade Tiradentes, SE, Brasil

Graduando(a) em medicina pela Universidade Tiradentes.

Adriano Dantas Hora, Universidade Tiradentes, SE, Brasil 

Graduando(a) em medicina pela Universidade Tiradentes.

Diana Maria de Sá Mota, Universidade Tiradentes, SE, Brasil 

Graduando(a) em medicina pela Universidade Tiradentes.

João Vitor Sabino Oliveira, Universidade Tiradentes, SE, Brasil 

Graduando(a) em medicina pela Universidade Tiradentes.

Thayanne Reis Barbosa de Santana, Universidade Tiradentes, SE, Brasil

Graduando(a) em medicina pela Universidade Tiradentes.

Any Eduarda Nanes de Oliveira Farias, Universidade Tiradentes, SE, Brasil

Graduada em Biomedicina em 2021. Licenciada em Biologia em 2024. Mestre em Biotecnologia Industrial em 2023. Doutoranda em Biotecnologia Industrial pela Universidade Tiradentes.

Guilherme Caxico de Abreu, Universidade Tiradentes, SE, Brasil

Graduando(a) em medicina pela Universidade Tiradentes.

Victor Cunha Sandrin, Universidade Tiradentes, SE, Brasil

Graduando(a) em medicina pela Universidade Tiradentes.

Felipe Mendes de Andrade de Carvalho, Universidade Tiradentes, SE, Brasil

Graduado em Biomedicina em 2017. Mestre em 2019 e Doutor em 2023 em Saúde e Ambiente pela Universidade Tiradentes.

References

BAIK, S. H.; BAYE, F.; MCDONALD, C. J. Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses. Menopause, 4 abr. 2024. DOI: 10.1097/GME.0000000000002335.

BALASUBRAMANIAN, R. et al. Metabolomic effects of hormone therapy and associations with coronary heart disease among postmenopausal women. Circulation: Genomic and Precision Medicine, v. 13, n. 6, p. e002977, 2020.

BENJAMIN, E. J. et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, v. 139, n. 10, p. 56–528, 5 mar. 2020.

CHEN, Z.; WU, C.; HUANG, Z. Association between estrogen replacement therapy and heart failure in postmenopausal women: a systematic review and meta-analysis. Preventive Medicine, v. 181, p. 107909, 19 fev. 2024.

EL KHOUDARY, S. R. et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation, v. 142, n. 25, 30 nov. 2020.

EL KHOUDARY, S. R. et al. Heart fat and carotid artery atherosclerosis progression in recently menopausal women: impact of menopausal hormone therapy: the KEEPS trial. Menopause, v. 27, n. 3, p. 255–262, mar. 2020.

GOLDŠTAJN, M. Š. et al. Efeitos da terapia de reposição hormonal transdérmica versus oral na pós-menopausa: uma revisão sistemática. Arquivos de Ginecologia e Obstetrícia, v. 307, n. 6, p. 1727–1745, 2023.

GORDON, J. L. et al. The effect of perimenopausal transdermal estradiol and micronized progesterone on markers of risk for arterial disease. Journal of Clinical Endocrinology & Metabolism, v. 105, n. 5, p. e2050–e2060, 2020.

GRAHAM, S. et al. Review of menopausal hormone therapy with estradiol and progesterone versus other estrogens and progestins. Gynecological Endocrinology, v. 38, n. 11, p. 891–910, nov. 2022.

JOHANSSON, T. et al. Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. BMJ, v. 387, p. e078784, 27 nov. 2024.

KIM, J. et al. Oral postmenopausal hormone therapy and genetic risk on venous thromboembolism: gene-hormone interaction results from a large prospective cohort study. Menopause, v. 29, n. 3, p. 293–303, 2022.

KIM, J. E. et al. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases. Scientific Reports, v. 10, p. 20631, 26 nov. 2020.

KOZAK, M. et al. Peripheral arterial disease in women. Vasa, 17 jul. 2024.

MACHUCA, J. N.; ROSALES-ALVAREZ, C. P. Doença cardiovascular em mulheres e o papel da terapia de reposição hormonal. Cureus, v. 16, n. 9, p. e69752, 2024.

MEHTA, J.; KLING, J. M.; MANSON, J. E. Risks, benefits, and treatment modalities of menopausal hormone therapy: current concepts. Frontiers in Endocrinology, v. 12, p. 564781, 26 mar. 2021.

MORRIS, G.; TALAULIKAR, V. Hormone replacement therapy in women with history of thrombosis or a thrombophilia. Post Reproductive Health, v. 29, n. 1, p. 33–41, 27 dez. 2022.

PANAY, N. et al. Oral estradiol/micronized progesterone may be associated with lower risk of venous thromboembolism compared with conjugated equine estrogens/medroxyprogesterone acetate in real-world practice. Maturitas, v. 172, p. 23–31, jun. 2023.

PORTERFIELD, L. et al. Does hormone therapy exacerbate other venous thromboembolism risk factors? Menopause, v. 31, n. 2, p. 123–129, 2024.

RENKE, G. et al. Cardio-metabolic health and HRT in menopause: novel insights in mitochondrial biogenesis and RAAS. Current Cardiology Reviews, v. 19, 6 fev. 2023.

SHUFELT, C. L.; MANSON, J. E. Menopausal hormone therapy and cardiovascular disease: the role of formulation, dose, and route of delivery. Journal of Clinical Endocrinology & Metabolism, v. 106, n. 5, p. 1245–1254, 23 abr. 2021.

UDDENBERG, E. R. et al. Menopause transition and cardiovascular disease risk. Maturitas, v. 185, p. 107974, 1 jul. 2024.

VAISAR, T. et al. Perimenopausal transdermal estradiol replacement reduces serum HDL cholesterol efflux capacity but improves cardiovascular risk factors. Journal of Clinical Lipidology, v. 15, n. 1, p. 151–161.e0, jan.–fev. 2021.

Published

2026-02-17

How to Cite

SANTOS, L. K. M.; HORA, A. D.; MOTA, D. M. de S.; OLIVEIRA, J. V. S.; SANTANA, T. R. B. de; FARIAS, A. E. N. de O.; ABREU, G. C. de; SANDRIN, V. C.; CARVALHO, F. M. de A. de. Influence of hormone therapy on cardiovascular health in postmenopausal women. JRG Journal of Academic Studies, Brasil, São Paulo, v. 9, n. 20, p. e092960, 2026. DOI: 10.55892/jrg.v9i20.2960. Disponível em: https://revistajrg.com/index.php/jrg/article/view/2960. Acesso em: 18 feb. 2026.

ARK