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What is HRT?

HRT is a treatment to help relieve peri-menopause or menopause symptoms. In the menopause, levels of oestrogen and progestogen fall, which can cause symptoms. HRT replaces the oestrogen and progestogen to help reduce symptoms such as hot flushes and night sweats, but it can also help prevent other problems.

Why am I taking HRT?

You will usually be prescribed HRT from your GP or menopause specialist because you may be suffering from menopause symptoms. What types of HRT are available?

There are different products (formulations) and delivery options for HRT. These include:

  • Patches
  • Gels
  • Implants
  • Tablets
  • Vaginal preparations (specialist use only)

Does this apply to me?

This leaflet applies to you if you were taking HRT before your stay in hospital and you have suffered a heart attack. This leaflet will discuss
the risks and benefits of taking HRT after a heart attack.

What does HRT do to normal coronary arteries?

Oestrogen has several benefits for the health of your coronary arteries.

Studies have found that oestrogen can have a protective role in coronary heart disease (CHD), especially if started in women younger than 60 years of age or if started within 10 years of the onset of the menopause. HRT has been found to reduce the build up of fatty plaques in your arteries (which can cause heart attacks) and reduce the risk of coronary events. 

What happens with my HRT now that I have had a heart attack?

Your HRT will be reviewed by the medical team, and they will discuss the options with you. The option taken will be your decision. The information in this leaflet should help you make your decision.

Can I continue to take my HRT?

There is no evidence to show that HRT needs to be stopped after having a heart attack, so it can be continued. However, the formulation may need to be changed. If you are on a tablet form of HRT then there is a slightly increased risk of having a blood clot, compared to topical formulations (e.g. patches, gels, vaginal preparations). 

You can stay on your usual prescription straight after your heart attack until you have decided which option is best for you. If you want to stop taking your HRT after having a heart attack, this is your decision and can be stopped if you wish. If you do stop, you may experience menopausal symptoms.

National guidance states that continuing HRT after a heart attack is ‘off-label’. This means that use after a heart attack is not within the original marketing authorisation of the medication but can be recommended for use as there is still enough evidence to support safe use.

What are the benefits of continuing HRT?

There are multiple benefits of taking HRT, including:

  • Control of the symptoms you may be experiencing due to the menopause.
  • Reduces risk of osteoporosis & fractures related to osteoporosis.

What are the risks of continuing HRT?

As with all medications, there are some risks of taking HRT. These risks will have been weighed up by your doctor before they started you on HRT (and before you had a heart attack).

Risks include: 

  • Increased risk of blood clots in legs or arms for tablet preparations. There is no increased risk for patches or gels (topical formulations).
  • Increased risk of breast cancer. This risk increases after you have taken HRT for more than 5 years and are over 50. 
  • Increase risk of endometrial cancer. However, this is if you are taking oestrogen-only HRT when you have a uterus present.
  • Increased risk of having a stroke if you are over the age of 60 and taking HRT in tablet form.

What else can I do to improve my heart health?

Overall, heart health is very important after a heart attack, whether you are taking HRT or not.

Some ways you can improve your heart health include:

  • Stopping smoking – Nicotine replacement therapy (NRT) can help you with this. The ward team can refer you to a specialistsmoking cessation team to help increase your chance of successfully quitting.
  • Weight loss – If you are overweight.
  • Improved diet – the Mediterranean diet is associated with improved health benefits. Information leaflets can be given to you before you go home.
  • Increased exercise – you will be referred to the Cardiac Rehabilitation Team after your heart attack who will guide you through returning to exercise and provide education sessions.
  • Medications – you will be started on several medications after your heart attack. Taking these is critical to help prevent another heart attack.
  • Lowering blood pressure (if it is high).
  • Ensuring good diabetes control (if you are diabetic).

What do I do when I get discharged?

Your discharge summary will clearly state that the hospital team are happy for you to continue your current HRT. 

If you are on a tablet form of HRT, then your discharge summary will contain a recommendation that your GP conducts a HRT review soon after you are discharged to review the formulation of your HRT. 

Who will be involved with my HRT once I go home?

The British Menopause Society recommends that women who are on HRT and have had a heart attack event should be under supervision of a specialist menopause clinic. If you are not already under this clinic, then your GP should be able to refer you.

Take home message:

If you have had a heart attack, you do not need to stop your HRT if you do not want to.

There is added benefit from taking a statin tablet alongside your HRT, this will usually be started in hospital if you were not already taking one. If you have any concerns regarding your statin, please talk to your GP or pharmacist.

Please use the information in this leaflet to help you make your decision. You can show this to your GP which may also help with decision making.

For further information in matters relating to heart disease, perimenopause and menopause please access the websites below:

There are many other resources available, which can be accessed via your GP or menopause specialist.