To take hormone replacement therapy (HRT) or not remains a big question in the minds of women as they age.

Not all that long ago women were strongly encouraged, across the board, to take female hormones. A combination of estrogen and progestin were prescribed to help alleviate problems such as sleeping at night and hot flashes, among other things. But in 2002, a Women’s Health Initiative study using synthetic hormones found that combined hormones (estrogen plus a progestin) and placebos given to about 16,000 women for five years yielded some serious health concerns. Those included an increase in heart attack and stroke, breast cancer, endometrial cancer, and dementia.

HRT was scaled back considerably.

In women who had not reached age 60, however, the hormones had neutral or slightly favorable cardiac effects.

Researchers from the Keck School of Medicine at the University of Southern California recently confirmed that hormone therapy can slow the buildup of plaque in arteries, but it must be taken within six years of menopause.

The study, published in the New England Journal of Medicine, is the first to directly assess the notion that postmenopausal hormone therapy’s cardiovascular effects vary based on when a woman starts hormone replacement therapy (HRT). The trial did not delve into whether estrogen and progesterone actually reduced heart attacks and strokes.

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The Study
Researchers looked at data from more than 600 postmenopausal women who did not have a history of cardiovascular disease or diabetes. The women were put into two groups: those who were within six years of menopause, and those who were 10 years or beyond menopause.

They were randomly assigned to take either oral estradiol (with progesterone gel) or a placebo that included a gel. Every six months, they looked at their carotid artery intima-media thickness (CIMT).

“When it comes to preventing vascular degeneration through hormone therapy, timing is key.”

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After a median of five years of HRT, women in the early postmenopausal group who took estradiol with or without progesterone had a slower build up of plaque compared to those taking placebos. The late menopausal group had the same rates of artery plaque buildup whether they took the hormones or the placebo.

Dr. Howard N. Hodis, director of the Atherosclerosis Research Unit and professor of medicine and preventive medicine at the Keck School of Medicine (also the lead author), said in a statement that cardiovascular benefits of hormone therapy depend on when the therapy starts.

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Dr. Wendy Mack, an associate professor of preventive medicine at the Keck School of Medicine and fellow researcher, told LifeZette that the hormone-timing hypothesis has been suggested over the past few years. But her institution’s study was the first to directly test that hypothesis by breaking participants into early and late post menopause.

“We’ve found solid evidence supporting that when it comes to preventing vascular degeneration through hormone therapy, timing is key,” Mack told LifeZette. “And perhaps this model of treatment is applicable to other degenerative diseases, as well.”

The Timing Factor
“This study is one of many that continue to build a case for the importance, and benefit, of hormone therapy,” said Dr. Douglas Lord, medical director of the Nava Health & Vitality Center, which has locations throughout Maryland and in Washington, D.C.

He said that though studies show an advantage to starting hormone therapy within six years, it “certainly doesn’t mean that after six years there is no benefit.”

“You get the best results within the first six years,” he said.

As for the battle over using synthetic or bio-identical hormones, that’s a debate that still rages.

In the latest study, researchers used bioidentical hormones that can be derived from plant and animal sources. (Actress Suzanne Somers has lauded bioidentical hormone replacement therapy, or BHRT, in her many books.)

“The thing that really confuses everyone is that the drug companies are pushing synthetic drugs or estrogen orally,” said Lord. He said the most important thing about hormone therapy is for it to be customized.

“Our system in America doesn’t customize anything to anybody,” he added.