Is it good to avoid oral contraceptive pills after 40 years?

Question

Hello doctor,

I have a question. Estrogen shows cardioprotective effects before menopause. But, it increases the risk of CVS diseases if taken in oral contraceptive pills. And, they say that oral contraceptive pills should be avoided after 40 years because of CVS complications.

I am not getting it. If it is cardioprotective, then why cannot it be given after 40 when estrogen levels in the body decrease? Also, I wanted to know, whether these side effects of oral contraceptive pills are dose-dependent. Because, normally in young women estrogen is cardioprotective, but if given extra from the outside, it is increased in the body than required and so, it causes complications. Is this true? Please explain.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Natural estrogen is cardioprotective as it increases the level of HDL (high-density lipoprotein) and decreases the level of LDL (low-density lipoprotein). Oxidation of LDL cholesterol is believed to be the initiator of atherosclerosis. Estradiol and other estrogens are believed to inhibit this process.

Hormone replacement therapy (HRT) rapidly increases the level of C-reactive proteins in the body, a marker of inflammation associated with an increased risk of cardiovascular disease. Recently, two major studies found that HRT in postmenopausal women increases the risk of breast cancer.

Another study proved that HRT in postmenopausal women increases the risk of cardiac events and thrombosis. Hence, women should be advised to cease therapy postmenopause. However, a detailed analysis showed that the time of initiating HRT postmenopause plays a crucial role. When initiated within five years of menopause in a healthy woman estrogen-based HRT has far more benefits than adverse outcomes.

The pros of HRT include reducing symptoms of menopause, reducing osteoporosis dementia, and colon cancer, and improving the cardiovascular system. The cons of HRT are doubles the risk of thromboembolism and doubles the risk of breast cancer. So, the pros and cons are to be evaluated before initiating HRT in postmenopausal women.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.