Menopause HRT and Heart Health: What 2026 Studies Show

For decades, women have been wary of hormone replacement therapy (HRT) because of possible harm to the heart and blood vessels. In November 2026, two large studies added weight to the case for its safety, and they quickly became one of the most talked-about health stories of the month.

Study 1: 52,000 women followed for 12 years

At the American Heart Association (AHA) Scientific Sessions in Chicago, researchers presented data from Clalit Health Services in Israel. They analysed the records of 52,330 women aged 45 to 59 with no history of heart disease, blood clots or cancer. Half started HRT and half did not. Average follow-up was 12 years, and up to 23 years for some women.

The results, as reported by Healio and the AHA news release:

• Heart attack, stroke or other heart disease: 4.4% in the HRT group vs 4.6% without HRT
• Death before age 80: 1.3% vs 1.2%
• Blood clots: 0.33% in both groups (174 vs 175 cases)

Notably, the results did not depend on the type of product. Pills, patches and gels were equally safe. The study’s lead author called the lack of any difference in blood clots “the genuine surprise.”

Study 2: Heart protection when started early

The second study was published in JAMA Internal Medicine. Its authors used data from the US-based SWAN project: 2,737 women with hot flushes, 755 of whom started hormone therapy.

According to the PubMed abstract, starting HRT was linked to a 22% lower risk of cardiovascular events. Women who began therapy within 10 years of menopause had a 27% lower risk. Women who started later showed no protective effect.

Why this matters right now

In November 2025, the US FDA removed the “black box” warning from HRT products, and the number of women starting therapy has risen sharply since then. The new data addresses the key question many of them have: is it safe for the heart?

Where caution is still needed

These findings are not a reason to take hormones “for prevention”:

• Both studies are observational. They show an association, not cause and effect.
• The AHA data is preliminary and has not yet been peer reviewed.
• The authors of the JAMA paper state plainly that their results should not be used to support HRT for preventing heart disease.
• Other research points the other way. An analysis of 170,000 women in UK Biobank linked HRT to a 13% higher risk of atherosclerotic cardiovascular disease, driven mainly by ischaemic stroke (Acta Obstetricia et Gynecologica Scandinavica).
• Testosterone is a separate issue. A study presented at The Menopause Society meeting linked its use after menopause to a higher risk of cardiovascular events (Verywell Health).

Practical takeaways

1. For healthy women aged 45 to 59, modern HRT does not appear to carry a meaningful risk to the heart.
2. Timing matters. Starting within the first 10 years after menopause appears to be the best window.
3. The decision to use HRT should always be made with your doctor, taking into account your personal history, blood clot risk and breast cancer risk.