For most healthy women who start hormone therapy around menopause, today’s HRT doesn’t appear to raise the risk of heart attack, stroke or early death. That’s the headline from a new study of more than 52,000 women followed for an average of 12 years, and it adds to evidence that HRT heart risk depends on when you start, what type you use and your own health history.
Here’s what the study found, why HRT got its scary reputation in the first place, and what you can ask your doctor if you’re weighing it up.
What the new study found about HRT heart risk
The research comes from Israel and is being presented at the American Heart Association’s Scientific Sessions 2026. According to the American Heart Association’s news release, the team used health records from Clalit Health Services to look at 52,330 women aged 45 to 59. None of them had a history of heart disease, blood clots or cancer when they entered the study.
About half started HRT, mainly as tablets, patches or both. The other half had recently seen a gynaecologist but never started HRT. The two groups were matched on age, body weight (BMI), blood pressure, cholesterol, diabetes, smoking and income level. Records were checked for up to 23 years.
| Outcome | Women on HRT | Women not on HRT |
|---|---|---|
| Heart attack, stroke or related heart disease | 2,311 (4.4%) | 2,383 (4.6%) |
| Death from any cause before age 80 | 659 (1.3%) | 653 (1.2%) |
| Blood clots in the veins | 174 (0.33%) | 175 (0.33%) |
In plain terms, the two groups ended up almost the same. The results were also similar whether women used tablets, patches or gel.
Why this study can’t settle the question on its own
The study is observational, so it shows a link (or here, the lack of one), not cause and effect. The researchers themselves point out several limits:
- Women who choose HRT may differ in ways the records don’t capture, such as exercise, diet, other health problems or how bad their symptoms were.
- Women were grouped by the first type of HRT they used. Switching products later wasn’t tracked.
- It’s a conference abstract, so it hasn’t yet been through full peer review in a journal.
- Everyone in it was 45 to 59 and free of heart disease, clots and cancer at the start. The results don’t tell you much about older women or women who already have those conditions.
So it’s reassuring, but it doesn’t mean HRT protects your heart. The NHS puts it this way: research has shown HRT has little or no effect on the risk of coronary heart disease.
Why HRT got a bad name: the Women’s Health Initiative
Many women stopped HRT, and many doctors stopped prescribing it, after the Women’s Health Initiative (WHI), a large set of US trials. In July 2002 the combined estrogen plus progestin arm was halted early because it showed no overall benefit and a higher risk of invasive breast cancer, with more heart disease, stroke and lung clots also seen.
The later long-term WHI report in JAMA covered 27,347 women aged 50 to 79. Some details that got lost in the headlines:
- The trials used one specific older regimen: conjugated equine estrogens, with or without medroxyprogesterone acetate.
- Women joined at any age from 50 to 79, not only around the time of menopause.
- For women who’d had a hysterectomy and took estrogen alone, risks and benefits were more balanced, and women aged 50 to 59 had more favourable results for heart attack and death from any cause.
- Neither regimen changed overall death rates.
That’s a big part of why researchers started asking whether age and timing change the picture.
The timing hypothesis: does starting age matter?
The “timing hypothesis” is the idea that HRT behaves differently in the body depending on when you start it. Starting near menopause appears to carry less heart risk than starting many years later.
The 2022 hormone therapy position statement from The Menopause Society (then called the North American Menopause Society) says that for women younger than 60, or within 10 years of menopause, with no reasons to avoid it, the benefit-risk balance is favourable for treating hot flushes and preventing bone loss. For women who start more than 10 years after menopause or after 60, the balance looks less favourable because of greater absolute risks of heart disease, stroke, clots and dementia.
Cleveland Clinic gives the same advice: heart disease risk goes up if you begin HRT 10 years after menopause starts, and it’s lower if you start before 60 or within 10 years of menopause.
Regulators have shifted too. In November 2025 the US Food and Drug Administration began removing the boxed warnings about heart disease, breast cancer and probable dementia from HRT labels. It kept the warning about womb (endometrial) cancer for estrogen-only products, and its label recommendation is to start systemic HRT within 10 years of menopause or before age 60.
Tablets vs patches and gels: blood clots and stroke
How the estrogen gets into your body matters. Tablets are swallowed, while patches, gels and sprays deliver estrogen through the skin. Here’s how the NHS sums it up:
| Risk | HRT tablets | Patches, gels and sprays |
|---|---|---|
| Blood clots | Can increase the risk, though it’s still very low | Do not increase the risk |
| Stroke | Slightly increase the risk, which stays very low, especially under 60 | Do not increase the risk |
| Coronary heart disease | Little or no effect | Little or no effect |
If you’ve had a clot before, or have other clot risk factors, your doctor is likely to suggest a patch or gel rather than tablets. In the new Israeli study, clot rates were the same in both groups, but most of that evidence on route of delivery comes from earlier research.
HRT and breast cancer
Breast cancer is the risk most women ask about. According to the NHS:
- Combined HRT (estrogen plus progestogen) slightly raises breast cancer risk. That’s around 5 extra cases in every 1,000 women who take it for 5 years.
- The risk rises the longer you take it and the older you are, and it falls again after you stop.
- Estrogen-only HRT causes little or no increase. It’s usually only an option if you’ve had your womb removed, because estrogen alone can thicken the womb lining. Our guide to life after uterus removal covers that situation.
Keep up with breast checks and screening while you’re on HRT, and learn the symptoms of breast cancer so you know what to report.
Who shouldn’t take HRT
The NHS and Cleveland Clinic list situations where HRT may not be suitable, or where you’d need a different type or extra checks first:
- A past or current breast, ovarian or womb cancer
- A history of blood clots (a patch or gel may still be possible)
- High blood pressure that isn’t treated yet; it needs controlling before you start
- Liver disease, or gallbladder disease
- Vaginal bleeding that hasn’t been checked
- Pregnancy
If HRT isn’t right for you, there are non-hormonal options. Some women look at supplements too; our review of natural supplements for perimenopause explains what the evidence does and doesn’t support.
Questions to ask your doctor before starting HRT
The Menopause Society says HRT risks differ by type, dose, how long you take it, the route, when you start and whether a progestogen is included. That gives you a useful checklist for your appointment:
- How many years am I past my last period, and does that change my risk?
- Is a patch or gel better for me than tablets, given my clot and stroke risk?
- Do I need a progestogen, and which one?
- What’s my own heart risk right now, based on my blood pressure, cholesterol, blood sugar and smoking?
- How often should we review whether I still need it?
- What bleeding pattern is normal on this HRT, and what isn’t?
- What are my options if I can’t take hormones?
When to see a doctor
Call your local emergency number straight away if you have:
- Chest pain, pressure or tightness, especially if it spreads to your arm, jaw or back. If you’re not sure, read how to tell gas from a heart attack, but don’t wait it out.
- Sudden shortness of breath or chest pain together with pain or swelling in one leg, which can mean a clot has reached the lungs
- A drooping face, a weak arm or slurred speech. Learn the BE FAST stroke signs.
See your doctor soon if you notice:
- Throbbing pain or swelling in one leg, usually the calf or thigh, with red or darkened skin
- Irregular vaginal bleeding that lasts more than 6 months after starting HRT, bleeding that gets heavier, or bleeding after your periods had stopped for a while
- A new breast lump, skin dimpling or nipple change
- Side effects that are severe or last longer than 3 months
Frequently asked questions
Does hormone therapy cause heart disease?
For healthy women who start near menopause, current evidence, including this new study, doesn’t show a meaningful rise in heart disease. Starting more than 10 years after menopause or after 60 carries more risk, so timing matters.
Can HRT protect your heart?
Don’t count on it. The NHS says HRT has little or no effect on coronary heart disease risk, and the new study can’t prove cause and effect. HRT is prescribed for menopause symptoms and bone protection, not to prevent heart disease.
Is it safe to start HRT after 60?
It can still be an option for some women, but The Menopause Society says the balance of benefits and risks is less favourable when you start after 60 or more than 10 years past menopause. You’d need a careful, individual review with your doctor.
Are HRT patches safer than tablets?
For clots and stroke, yes. The NHS says patches, gels and sprays don’t increase the risk of blood clots or stroke, while tablets slightly increase both.
Why did the FDA remove the black box warning on HRT?
In November 2025 the FDA started removing the boxed warnings about heart disease, breast cancer and probable dementia, and said when to start and how long to use HRT are decisions for you and your prescriber to make together. The warning about womb cancer stays on estrogen-only products.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.
