From the Guidelines
Menopausal hormone therapy (MHT) is generally not recommended for patients with spontaneous coronary artery dissection (SCAD) due to the potential risk of recurrent dissection and the uncertain effects of MHT on SCAD incidence and recurrence. The use of exogenous hormones, including estrogen and progesterone for contraceptive and post-menopausal therapy, is usually avoided if possible, and they are used only if the nonhormonal options have been considered and the benefits of HT outweigh potential risks 1.
Key Considerations
- SCAD occurs primarily in women and is associated with pregnancy, suggesting a presumed pathophysiological association with female sex hormones, although the precise relationship remains unclear 1.
- Patients who experience SCAD while receiving HT should have their indications for HT reassessed, and unless there are compelling reasons to continue, HT should be discontinued 1.
- Indications for initiation of exogenous HT include premature and early surgical menopause, severe vasomotor symptoms that cannot be managed with lifestyle or nonhormonal treatments, and local treatment of genitourinary syndrome of menopause 1.
- Locally applied vaginal estrogen is generally thought to be safe because there is minimal systemic absorption, but this should be considered on a case-by-case basis 1.
Alternative Management Strategies
- Non-hormonal alternatives should be considered first for managing menopausal symptoms, such as selective serotonin reuptake inhibitors (SSRIs) or gabapentin for hot flashes, sleep disturbances, and mood symptoms.
- Lifestyle modifications, including regular exercise, maintaining a healthy weight, avoiding triggers like extreme physical exertion, emotional stress, and stimulants, can help manage both SCAD risk and menopausal symptoms.
- Each case should be individually evaluated by a cardiologist and gynecologist working together to determine the best course of treatment, considering the potential benefits and risks of MHT or alternative therapies 1.
From the Research
MHT Safety for SCAD Patients
There is no direct evidence in the provided studies to suggest the safety of Menopausal Hormone Therapy (MHT) for Spontaneous Coronary Artery Dissection (SCAD) patients.
- The studies focus on the diagnosis, management, and outcomes of SCAD patients, with no mention of MHT 2, 3, 4, 5.
- One study discusses the use of selective serotonin reuptake inhibitors (SSRIs) and their adverse effects, but does not relate to MHT or SCAD patients 6.
- The management of SCAD patients typically involves antiplatelet therapy, β-blockade, and revascularization in certain cases, but does not mention MHT as a treatment option 2, 3, 4.
- The studies highlight the importance of close monitoring and follow-up for SCAD patients due to the risk of recurrent dissection and major cardiovascular events, but do not provide information on the safety of MHT for these patients 2, 3, 4, 5.