Oestrogen replacement therapy is a form of hormone therapy in which oestrogen (the main female sex hormone) is provided to women whose natural oestrogen levels have fallen, most commonly as a result of the menopause. During the menopause, the ovaries stop producing oestrogen and progesterone, leading to symptoms including hot flushes, night sweats, vaginal dryness, mood changes, and reduced bone density. Oestrogen replacement is the most effective treatment for these symptoms.
Oestrogen replacement therapy is usually prescribed as part of combined hormone replacement therapy (HRT), which includes a progestogen alongside oestrogen in women who still have a uterus (to protect the uterine lining from oestrogen-driven overgrowth). Women who have had a hysterectomy can take oestrogen alone. HRT is available in several forms including tablets, patches, gels, and sprays, each with slightly different risk and benefit profiles.
The relationship between oestrogen and cardiovascular health is complex. Before the menopause, natural oestrogen appears to offer some cardiovascular protection: premenopausal women have lower rates of coronary artery disease than men of the same age, and this advantage is progressively lost after the menopause. Large clinical trials have shown that the timing and type of therapy matters: HRT started in women more than 10 years past the menopause or who already have established cardiovascular disease does not appear to reduce cardiac risk, whereas HRT started within 10 years of the menopause in younger women has a more favourable cardiovascular profile.
For women who have survived cardiac arrest and are menopausal, decisions about HRT should be made on an individual basis with their GP or cardiologist, weighing symptomatic benefit, bone health, breast cancer risk, and the cardiovascular factors specific to their own condition and the cause of the arrest.
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