Hormone therapy not tied to higher heart risk, 23-year study finds

If worry about your heart is the reason you have put off hormone therapy, a large new study gives you something to bring to your next appointment.

Researchers in Israel followed more than 52,000 women for an average of 12 years, and as long as 23 years for some, and found that today’s menopause hormone therapy did not raise the risk of heart attack, stroke, blood clots or death. The American Heart Association shared the findings Monday.

Lead investigator Ronen Arbel of Clalit Health Services in Tel Aviv said concern about the heart is one of the most common reasons women decline treatment, and one reason some clinicians hesitate to offer it. Stacey Rosen, a past volunteer president of the heart association who was not involved in the research, said the results add to growing evidence that current options appear safe for healthy women who start near the time of menopause.

Much of the old fear traces back to research on women who began hormones years after menopause, often with formulations that differ from what is prescribed today. Use has dropped anyway: a Mayo Clinic study published in June found hormone therapy use among U.S. women 40 and older fell from 4.4% in 2007 to 1.7% in 2023. In November 2025, the Food and Drug Administration removed boxed warnings about breast cancer, heart disease and dementia from estrogen products, though clinicians still weigh risks woman by woman.

What treatment looks like: Systemic hormone therapy means estrogen, taken as a pill, patch, gel or spray. If you still have a uterus, you also take a progestogen to protect its lining. Patches, gels and sprays carry a lower clot risk than pills, and micronized progesterone appears to carry a lower breast cancer risk than synthetic progestins. If vaginal dryness or painful sex is your main complaint, low-dose vaginal estrogen works locally and very little reaches the bloodstream.

The pros: Most women see hot flashes drop by about 75%. Hormone therapy also treats night sweats, vaginal dryness and urinary symptoms, and it protects your bones, cutting fracture risk by roughly 20% to 34% when started before 60.

You do not have to wait for your last period.

The cons: Risks rise with age and with years of use. Pills raise the chance of blood clots. Combined estrogen and progestogen modestly raises breast cancer risk over time; among women 50 to 69, about 79 in 1,000 on combined therapy develop breast cancer over five years, compared with 59 in 1,000 not taking hormones. Some women get breast tenderness, bloating or spotting. And hormone therapy is not prescribed to prevent heart disease or dementia, or to lose weight.

Too early? Too late? You do not have to wait for your last period. Hormone therapy can begin in perimenopause, when symptoms often hit hardest. Menopause Society guidelines say benefits generally outweigh risks for healthy women who start before 60 or within 10 years of menopause. Starting later is not automatically off the table, but the math changes, and it calls for a careful look at your personal risks. Vaginal estrogen can be used at almost any age.

Who should not take it: Women with a history of breast cancer or other estrogen-sensitive cancer, blood clots, stroke, heart disease, active liver disease, uncontrolled high blood pressure or unexplained vaginal bleeding are generally not candidates for systemic hormones.

If you’re interested, here’s your plan: Track your symptoms for two weeks, including hot flashes, sleep, mood and periods. Book a visit specifically to discuss menopause, not as an add-on at the end of a physical. Ask whether you are a candidate, which form and dose fit you, how long to stay on it and when to reassess. Skip compounded bioidentical hormones and pellets, which have inconsistent dosing. If your provider lacks menopause training, the Menopause Society keeps a directory of certified practitioners.