Is HRT safe for my mom’s atrial fibrillation at 59?

Question

Hello doctor,

My mom is 59 years old and in perimenopause. She has had two episodes of atrial fibrillation (AFib) recently, and now her doctor wants to start her on a beta-blocker and maybe anticoagulants. She is also having severe hot flashes and mood swings.

Could hormonal changes be triggering the AFib?
Are HRT (hormonal replacement therapy) options safe for someone with this heart rhythm issue?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Atrial fibrillation (AF) is a rhythm disorder in which the upper chambers of your heart produce an irregular, fast heart rate. This can lead to a variety of symptoms, including

Palpitations.
Shortness of breath.
Fatigue.
Anxiety.

Your need for anticoagulation (blood thinners) is determined after assessing the risk of thromboembolic phenomena and bleeding. A final decision is made based on a risk-benefit ratio. Your healthcare providers use different scoring systems to calculate these risks.

There is no direct relationship between atrial fibrillation and hormonal changes around the peri-menopause period. If the risk of bleeding is low, anticoagulants are considered safe to take during peri-menopause.

However, if you experience heavy bleeding during this time, anticoagulation can worsen it, requiring proper medical supervision. Some hormone replacement therapies (HRT) can increase the risk of thrombus formation and embolism. In such cases, anticoagulation plays a protective role.

There is no direct relationship between the worsening of atrial fibrillation and HRT. It is generally safe to take HRT if you have atrial fibrillation.

Please remember that atrial fibrillation often has secondary causes, such as

Hypertension.
Ischemia of the heart.
Structural heart disease.
Electrolyte imbalances.

Therefore, it is important to identify and treat the underlying cause to manage and avoid it. The main pillars of treatment include heart rate control (with beta-blockers), rhythm control, anticoagulation as needed, treating the underlying cause, and, if necessary, interventions like ablation.

I hope this information helps you.

Feel free to ask further queries.

Thank you.