Estrogens are cardio protective. The cardiovascular health of women is seen to be better than their male counterparts till the date when menopause sets in and the level of the sex hormones declines in women. The development of pharmaceutical expertise to separate and purify the female sex hormones in the early part of the twentieth century opened vistas for their use in post-menopausal women. Very soon, hormone replacement therapy become widely popular for improving the physical, psychological and cardiovascular health of post-menopausal women. It was known long before that unimpeded estrogenic action results in endometrial proliferation and increases the risk of endometrial carcinoma. Therefore, from the very beginning, hormone replacement therapy involves the use of progesterone in a cycle manner along with oestrogen. Numerous observational studies showed the benefits of HRT on the cardiovascular health of women.The use of hormone replacement therapy for presumed cardiovascular benefit continued for many years. For the first time, a study sponsored by the National Institute of Health, the Women’s Health Initiative showed that Hormone replacement therapy is associated with increased cardiovascular morbidity. The landmark study resulted in the drastic decline of hormone replacement therapy in post-menopausal women. The present recommendation of HRT in post-menopausal women is restricted to control of vasomotor symptoms and atrophic vaginitis in early menopause and should be withdrawn as early as possible. HRT has also been found to increase breast cancer, gallstones and migraine.
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