Skip to main content
  1. Right Decisions
  2. Maternity & Gynaecology Guidelines
  3. Gynaecology
  4. Back
  5. Gynaecology guidelines
  6. Hormone Replacement Therapy and Cardiovascular Disease (689)
Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Hormone Replacement Therapy and Cardiovascular Disease (689)

Please report any inaccuracies or issues with this guideline using our online form

Cardiovascular disease is common; therefore we will inevitably see women with cardiovascular disease who wish to use hormone replacement therapy (HRT).

Until the late 1990s oestrogen was thought to protect against coronary heart disease (CHD).  However, an RCT, the Women’s Health Initiative (WHI) found an early, transient increase in coronary events in the combined HRT (oestrogen plus progestogen) arm.  However, the average age of participants in WHI was 63 years old, and more recent subgroup analyses of data from the WHI trials have questioned these results.  HRT use was stratified by age and time since menopause, and this analysis demonstrated more favourable results for all-cause mortality and myocardial infarction in women aged 50-59, and those starting HRT close to menopause (1).  The Danish Osteoporosis Prevention Study (DOPS) (2), an open label RCT, showed that HRT was associated with a reduction in cardiovascular disease in women of the same age group.

The NICE Guideline on Menopause (NG23) provides guidance on the use of HRT and the risk of cardiovascular risk, and this is summarized below.

Resources

Use the button below to access this item.

Access this resource

Editorial Information

Last reviewed: 01/06/2019

Next review date: 30/06/2024

Author(s): Jenifer Sassarini.

Approved By: Gynaecology Clinical Governance Group

Document Id: 689

Related resources

NICE Guidance: NG23. Diagnosis and management of menopause. https://www.nice.org.uk/guidance/ng23/

BMS Consensus Statements – www.thebms.org.uk

Alternatives to HRT for the Management of Symptoms of the Menopause (SAC Opinion Paper 6). RCOG; 2010. http://www.rcog.org.uk/womens-health/clinicalguidance/alternatives-hrt-management-symptoms-menopause  

References
  1. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013 Oct 2;310(13):1353-68. PubMed PMID: 24084921. Pubmed Central PMCID: 3963523.
  2. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. 2012 2012-10-09 22:32:25;345.
  3. Windler E, Stute P, Ortmann O, Mueck AO. Is postmenopausal hormone replacement therapy suitable after a cardio- or cerebrovascular event? Archives of Gynecology and Obstetrics. 2015;291(1):213-7.
  4. Shlipak MG, Angeja BG, Go AS, et al. Hormone Therapy and In-Hospital Survival After Myocardial Infarction in Postmenopausal Women. Circulation. 2001;104(19):2300-4.
  5. Tackett AH, Bailey AL, Foody JM, et al. Hormone replacement therapy among postmenopausal women presenting with acute myocardial infarction: Insights from the GUSTO-III trial. American Heart Journal. 2010 10//;160(4):678-84.
  6. Mikkola TS, Tuomikoski P, Lyytinen H, et al. Increased Cardiovascular Mortality Risk in Women Discontinuing Postmenopausal Hormone Therapy. J Clin Endocrinol Metab. 2015 Dec;100(12):4588-94. PubMed PMID: 26414962.
  7. Renoux C, Dell'aniello S, Garbe E, Suissa S. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ. 2010;340:c2519. PubMed PMID: 20525678.