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Estrogen supplies protective profits that may assist women delay heart disease. It might seem as if women do not acquire heart condition since they incline to acquire it later in life than men, largely due to the protective effects of natural estrogen. As long as women are having regular menstrual cycles, they enjoy a significant, although not absolute, level of protection. Naturally produced estrogen is linked with lower levels of LDL (“bad”) cholesterol and triglycerides and higher HDL (“good”) cholesterol. While a woman’s estrogen production plummets in her late forties to early fifties, she begins to lose her hormonal advantage.

Because decades, experts advised women to take hormone replacement therapy (HRT)  to protect their hearts as well as to relieve menopausal symptoms and strengthen their bones. Estrogen’s heart-protective properties looked so promising that nearly half of all postmenopausal female physicians took HRT, a rate higher than that of the general public, according to a 1997 study.

That all converted in 2002, when preliminary results from the Women’s Health Initiative, a 15-year research program, caused a dramatic turnaround in the thinking about HRT. Compared with women who did not take HRT, women who took Prempro, a combination of estrogen and progestin, had a startling 29 percent increase in deaths from heart disease, along with a 22 percent increase in total cardiovascular disease. These results stunned the health community and caused a great deal of confusion in the general public.

Simply as it comes out, the HRT story is probably far from over. A review and analysis of many of the published HRT studies recently appeared in the Journal of General Internal Medicine. The authors pointed out possible explanations for the disparities between the earlier observational HRT studies of women who had chosen, in consultation with their physicians, to be on HRT and the more recent controlled trials. One factor that appears to be important is the timing of when HRT is started. Those women who begin it later appear to be more likely to experience heart attacks than those who begin HRT soon after menopause. In addition, much of the increased risk seems to occur in the first year HRT is started and may be due to an increased tendency to develop blood clots in the first year of HRT use.

Whether beginning HRT earlier after menopause and maybe at lower dosages is securer is frankly unknown at this time. Therefore, any decision on whether to begin HRT should be made with your physician after careful review of the potential risks and profits for your especial situation.