How does menopausal hormone therapy (HT) affect heart health in women?

From GLP-1 medications to fitness trackers and hormone therapy, today’s medical advancements are reshaping how women think about their health. These topics are lighting up podcasts, social media channels, and everyday conversations among women. At MHIF’s recent Hope, Health & Heart event, our panel of cardiologists covered some of these emerging trends and their impact on heart health. Attendees learned about cardiovascular disease risk factors in women, the role of estrogen, reliability of fitness trackers, and tips for heart disease prevention and screening. We’re taking a closer look at some frequently asked questions through a series of blogs, so women can feel informed and empowered on their heart health journey.

Menopause & Hormones

In the United States, the average age of menopause is around 51. In the years leading up to it—known as perimenopause—and throughout menopause itself, estrogen levels steadily decline. This hormonal shift can bring about symptoms like irregular cycles, sleep disturbances, mood changes, and even differences in hair and skin. One of the most noticeable effects, though, comes in the form of hot flashes and night sweats, often grouped together as “vasomotor symptoms.” Because these can disrupt daily routines and rest, they are typically the symptoms that drive women to explore possible treatments.

Menopausal hormone therapy (HT) is one option. It involves taking hormones—most often estrogen, sometimes combined with progesterone—to replace what the body no longer produces in the same amounts after menopause. Depending on a woman’s health history and the severity of her symptoms, discussing HT with a healthcare provider can help determine whether it might offer meaningful relief and improve day-to-day quality of life.

Research also shows that timing matters. Women who start hormone therapy closer to the onset of menopause, during perimenopause or early post menopause, may experience fewer risks than those who begin the therapy later in life.

History of Hormone Therapy

Let’s first go back about 25 years ago when projects such as the HERS trial and Women’s Health Initiative began researching how HT affected heart health in women. Unfortunately, these studies showed negative cardiovascular outcomes in the women enrolled in the trials, which sparked controversy surrounding HT for many years. These early studies had several flaws – most notably, the fact that most women were already over age 60 and postmenopausal at the time of enrollment.

Since then, recent studies have painted a different picture. When HT is given to younger women, closer to the onset of menopause, the negative cardiovascular outcomes were less likely. Today, HT is considered safe for women who are early in their menopause journey, maintain a healthy weight, are non-smokers, have normal blood pressure, and are physically active. Women with conditions such as diabetes, obesity, autoimmune disorders, high blood pressure, cardiovascular disease, or are at high risk for breast cancer may need to consider alternative treatments.

Hormone Therapy & Cardiovascular Benefits

While hormone therapy (HT) is not intended as a treatment for preventing cardiovascular disease, it may offer heart-protective benefits when taken correctly. This is due to estrogen’s “cardioprotective” factors, meaning it can:

Reduce inflammation in the arteries
Increase HDL or “good” cholesterol and lower LDL or “bad” cholesterol
Promotes the health of heart muscle cells

Therefore, for women who begin HT early and meet the criteria for safe use, improved cardiovascular outcomes may be an added benefit. It can help lower their risk of developing diabetes, obesity, and high cholesterol — all of which are known risk factors for cardiovascular disease.

If you have menopause-related symptoms, discuss your HT options with your provider. These days, there are low-dose medications, different hormonal combinations, and patches and gels instead of pills that may be a better option for you. And remember, a heart healthy lifestyle can prevent 80% of cardiovascular disease! Visit the Nolan Family Center for Cardiovascular Health Prevention & Population Health page for lifestyle tips and decreasing cardiovascular risk. For women’s heart health resources, visit the Penny Anderson Women's Center for Cardiovascular Health page.

References: