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Cardiologia Ambulatoriale - Outpatient Cardiology https://www.cardiologiaambulatoriale.eu/hormone-replacement-therapy-and-hormone-therapies/ Export date: Mon Jul 20 18:32:46 2026 / +0000 GMT |
Hormone replacement therapy and hormone therapiesTerapia ormonale sostitutiva e terapie ormonali Federica Moscucci¹; Claudio Crescini²; Raffaella Michieli³ ¹ Azienda Ospedaliera Universitaria Policlinico Umberto I, DAI of Internal Medicine and Medical Specialties, Viale del Policlinico n. 155, 00185 Rome. Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, Italy ² President of Fondazione Confalonieri Ragonese, adjunct professor Humanitas University Milano ³ Women's Health and gender medicine of Italian College of General Practitioners and Primary Care - SIMG Abstract The article explores the complex relationship between hormone replacement therapy (HRT), hormonal contraceptives, assisted reproductive technologies, and cardiovascular risk in women. Sex hormones, including estrogens, progesterone, and androgens, play a crucial role in modulating cardiovascular function, influencing endothelial health, vascular reactivity, inflammation, and coagulation. Estrogenes, in particular 17β-estradiol, exert protective effects on the cardiovascular system, which with postmenopausal decline, contribute to an increased risk of hypertension, dyslipidemia and coronary heart disease. Hormonal contraceptives, particularly oral combined contraceptives (COCs), are widely used for fertility regulation but carry a high risk of venous thromboembolism and, to a lesser extent, arterial events. Low-dose formulations and progestogen-only contraceptives offer a more favorable cardiovascular profile and are recommended for women with known risk factors. Assisted reproductive technologies (ARTs) involve intensive hormonal protocols that temporarily increase cardiovascular risk. Gender-affirming hormone therapy (GAHT) for transgender people is associated with increased cardiovascular risk, especially in transgender men treated with testosterone and transgender women receiving estrogens and antiandrogens. Other endocrine disorders can further increase cardiovascular risk in women. Recent evidence supports the cardioprotective effects of HRT when started early after menopause, ideally within ten years or before the age of sixty, in line with the "timing hypothesis". The risk-benefit profile of HRT depends on age, comorbidities, route of administration, and hormonal type. Low-dose transdermal formulations combined with natural progestogens are associated with a lower thrombotic risk. Hormone therapy is not recommended for universal primary prevention, but it may be beneficial to symptomatic and low-risk women near menopause. The importance of personalized risk assessment, multidisciplinary approach, and evidence-based therapy to optimize cardiovascular outcomes in women receiving hormonal treatments is emphasized. Key words: Women; Cardiovascular Risk; Hormone Replacement Therapy; Estrogens; Progesterone; Menopause; Assisted Reproductive Technologies; Gender-Affirming Hormone Therapy. |
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Post date: 2025-12-03 15:38:36 Post date GMT: 2025-12-03 15:38:36 Post modified date: 2026-05-03 15:42:15 Post modified date GMT: 2026-05-03 15:42:15 |
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