LEARN: MHT and Heart Attacks

What is a Heart Attack and why does Estrogen Matter?

🫀 A blocked artery is the well-known cause of a heart attack. The blockage stops oxygen from reaching part of the heart muscle — and that’s what causes the pain. But in women, it’s not always a blocked artery. Women often experience vasospasm — a sudden narrowing of the blood vessels.

🩺 This is also why heart attacks in women can be harder to diagnose.

🔁 Different mechanism. Same risk. Same need for care.

🌸 The role of estrogen...

Estrogen is not just about hot flushes.

✅ Keeps arteries flexible

✅ Reduces inflammation

✅ Improves cholesterol

✅ Supports nervous system balance

But how interesting is it that having hot flushes is a risk factor for cardiovascular disease... It is not 'just' a hot flash!

📚 What Do the Guidelines Say?

The British Menopause Society (BMS) says:

❗ You do NOT need to automatically stop MHT after a heart attack.

✅ Safer forms (like transdermal estrogen) can still be used.

🧭 What Happens After a Heart Attack?

You may need:

💊 Blood pressure medications eg beta blockers/ACEI (ACE inhibitors) – improve heart pumping and lower blood pressure

💊 Blood thinners - decrease the risk of clotting as your body heals

💊 Statins – reduce future events by 25–30% (ie secondary prevention)

🧠 Lifestyle reset – sleep, stress, movement, food, quitting smoking

🌿 What About Your MHT?

You can:

🔽 Lower the dose

💉 Switch to transdermal estrogen (plus micronised progesterone if needed)

🚫 But you do not have to stop

🔬 Deep Dive – Estrogen protects the heart in over 20 ways (indirectly and directly!)

🌀 NO pathway → vasodilation, ⬇️ pressure

🔥 ⬇️ Inflammation (cytokines like TNF-α, IL-6)

💉 Improves lipid profile (⬇️ LDL, ⬆️ HDL)

🧠 Modulates nervous system – ⬇️ stress effects

🌱 Repairs blood vessels – angiogenesis & elasticity

✅ British Menopause Society, 2022

✅ Mendelsohn & Karas, Science, 2005

✅ Vitale et al., Best Practice, 2010

✅ Manson et al., JAMA, 2019

✅ Maas & Appelman, Netherlands Heart J., 2010

✅ Stuenkel C,. 2023

The British Menopause Society

Traditionally it was automatically thought that estrogen needs to be stopped. Your clinician will want the best for you - so if you are having and challenges, you could send them this link. Or print off the guidelines. We are all in this together!

The BMS Guideline- MHT after MI