Management of Menopausal Symptoms in Patients with Cardiac History

Contraindication of Hormone Therapy

The American College of Cardiology recommends that combined estrogen plus progestin hormone therapy should not be initiated for secondary prevention of coronary events in postmenopausal women with a history of cardiovascular events 1, 3, 4
The American Heart Association suggests that hormone therapy is contraindicated in women with a history of cardiovascular events, and should be immediately discontinued if a patient with a cardiac history is currently taking it, according to the Journal of the American College of Cardiology 3

Regular physical activity and weight management can help reduce vasomotor symptoms in menopausal women with a history of cardiac events, as recommended by the American Heart Association 1
Avoidance of triggers such as caffeine, alcohol, spicy foods, and hot environments can also help alleviate symptoms, although this recommendation is from Praxis Medical Insights, a similar recommendation is found in 1

Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) at low doses, such as paroxetine 7.5-10 mg daily, can be used to treat hot flashes in menopausal women with a history of cardiac events, as suggested by the American College of Cardiology 4, 6
Venlafaxine 37.5-75 mg daily is another option for treating hot flashes, according to the American Heart Association 6

Beta-blockers should be used indefinitely in women who have had a myocardial infarction or chronic ischemic syndromes unless contraindicated, as recommended by the American College of Cardiology 1, 4, 6
Aspirin therapy (75-162 mg) should be used in high-risk women unless contraindicated, according to the American Heart Association 1, 4
Angiotensin receptor blockers (ARBs) should be used in high-risk women with heart failure or ejection fraction ≤40% who are intolerant to ACE inhibitors, as suggested by the American College of Cardiology 1, 4