Taking HRT in perimenopause may ward off cardiovascular disease — SkimNews
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- Samar El Khoudary and colleagues at Virginia Commonwealth University tracked 2,737 women aged 42–52 from the Study of Women's Health Across the Nation over 20 years, finding 224 fatal and non-fatal cardiovascular events among participants.
- Women who started HRT within 10 years of vasomotor symptom onset were 27 percent less likely to experience cardiovascular events than non-users, while the protective effect was much less clear for those starting more than a decade after symptoms began.
- The study, published in JAMA Internal Medicine, found HRT's apparent protective effect was most pronounced among Black participants, who may be more likely to experience hot flushes and night sweats — a disparity researchers say needs further investigation.
- El Khoudary emphasized that the findings do not support using menopausal hormone therapy to prevent cardiovascular disease, and Tara Iyer at Brigham and Women's Hospital noted observational studies cannot establish causality.
- A separate recent study found oral HRT linked to a 0.09 percent higher annual risk of venous thromboembolism, 0.06 percent higher risk of ischemic stroke, and 0.03 percent higher risk of heart attack per year.
- The 2002 Women's Health Initiative trial originally linked HRT to increased breast cancer, heart attack, and stroke risk, but its methodology has since been questioned, and a 2021 study found HRT does not increase the risk of early death.
Why it matters: If randomized trials confirm the timing hypothesis, millions of women entering perimenopause could gain a cardiovascular benefit from earlier HRT initiation — but the 0.03–0.09 percent annual risks from oral formulations mean the calculus on when and how to prescribe remains unsettled. For now, the lead researcher is explicit: don't start HRT to prevent heart disease.
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