Hormone therapy started near menopause tied to 22% lower cardiovascular risk

Clinical takeaway: Cardiovascular concerns have long discouraged hormone therapy use for menopausal symptoms. This study offers reassuring evidence for the women most likely to consider treatment: starting therapy during perimenopause or within ten years of menopause was associated with lower cardiovascular risk.

Questions about cardiovascular safety have long complicated menopausal hormone therapy (MHT) counseling. Much of the trial evidence came from older postmenopausal women, leaving uncertainty about treatment started near menopause specifically for vasomotor symptoms.

Researchers used 20 years of data from the Study of Women’s Health Across the Nation to emulate a series of clinical trials. The analysis included 2,737 women with hot flashes or night sweats who had no prior cardiovascular disease or MHT use; 755 initiated systemic estrogen with or without a progestogen. During follow-up, 224 fatal or nonfatal cardiovascular events occurred.

Overall, starting MHT was associated with a 22% lower risk of cardiovascular events. The risk was 27% lower among women who began treatment within ten years of menopause, while no clear benefit was seen when treatment started later.

Black women had an estimated 49% lower risk with MHT initiation, whereas no clear reduction was observed among White women or women in other racial and ethnic groups. These subgroup findings warrant caution and further study.

The study results add evidence that the cardiovascular effects of MHT may depend on when treatment begins. For women seeking relief from hot flashes and night sweats near menopause, the results may help ease longstanding concerns about cardiovascular harm and support more informed treatment discussions.

“These findings point to women with vasomotor symptoms as those who may show cardiovascular benefit from hormone therapy initiated during the perimenopause and postmenopausal years,” said study author Rebecca C. Thurston, PhD, associate dean for Women’s Health Research at the University of Pittsburgh School of Medicine. “However, conclusions should be tempered by the observational nature of the study, and findings should not guide clinical practice.”

Source: Wang Z, et al. (2026 Sep 8) JAMA Intern Med. Menopausal hormone therapy and cardiovascular risk in midlife women with vasomotor symptoms