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The menopause and HRT: what every women needs to know

Fact sheet three: Heart disease and Osteoporosis

Am I at risk of Heart disease?

Most people think of heart disease as a male problem but post- menopausal women are equally at risk once the protective oestrogen has been lost.

Half of the deaths caused by heart disease are due to coronary artery disease, (angina, heart attack and heart failure). The problem is that most post-menopausal women probably don’t know they are at an increased risk from heart disease until symptoms become more serious. That makes early action and prevention even more important. Heart disease kills one in two post-menopausal women.

How can HRT help protect me from heart disease?

Although a lot of research has been done looking at the effect of oestrogen on the heart, blood vessels and blood fats (cholesterol), it is still not entirely clear how oestrogen confers its many protective effects. One thing is clear taking oestrogen reduce the risk of heart disease by as much as 40%.

What we do know is that oestrogen causes the level of low density fats which lead to atheroma or furring of the arteries. It also increases levels of high density fats which are protective. Oestrogen also seems to affect the blood vessels by countering the narrowing effect of fatty deposits and increasing the amount of blood to vital organs.

Can I do anything to reduce the risk?

Like most illnesses, heart disease is caused by a number of factors, which include:
Age, sex, family history, high blood presure, smoking, high cholesterol, diabetes, obesity, lack of exercise.

There are some things you can’t change like your age or family history. However it is important that you discuss these issues with your family doctor so that it is possible to identify if you are particular risk of heart disease. As well as considering HRT, you can do something positive about high cholesterol, smoking, obesity, and high blood pressure by making simple changes to your diet and lifestyle. (see fact sheet 5: you and your health).

Am I at risk of Osteoporosis?

Osteo (from the greek word for bone)- porosis (from the greek word for porosity) is the disease characterised by deterioration of bone structure and leads to weaker and increased susceptibility to fractures. Oestrogen prevents bone deterioration. After the menopause, women can lose up to 5% of their mass each year. That means that a 70 year old women may have lost half her bone mass, putting her at a greatly increased risk of fractures, especially of the wrist, spine or hip. Most women are unaware they have osteoporosis until they have a fracture. Again, some women may be at greater risk than others.

Although middle aged men lose a small amount of bone each year, women lose far more due to their lack of oestrogen after the menopause.
Risk factors include:

Early menopause or total hysterectomy, history of irregular periods, low body weight, anorexia, low dietary intake of calcium, lack of exercise, smoking, high alchol intake, family history of osteoporosis, long term use of oral steriods, hip or wrist fractures before the age of 65.

How does HRT help?

Oestrogen therapy in the form of HRT replaces the natural oestrogen, which will start to diminish after the menopause, so preventing or reducing bone loss. If you take HRT for at least 5 years, the risk of osteoporosis is reduced by 50%. 
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