Last week we talked about hormone therapy and your brain. This week, new research speaks to the question I hear most often in the clinic: is hormone therapy safe for my heart?
This week's research: timing and the heart
A study published yesterday in JAMA Internal Medicine followed 2,737 women from the long-running Study of Women's Health Across the Nation (SWAN), tracking up to 20 years of health data. All of them had hot flashes or night sweats, none had heart disease at the start, and none had used hormone therapy before the study.
The finding: women who began hormone therapy during perimenopause or early postmenopause had a 22% lower risk of cardiovascular events - heart attack, stroke, heart failure, and related procedures - than women who never used it.
Two details matter most. First, timing. Women who started hormone therapy within 10 years of menopause onset saw the greatest benefit (about a 27% lower risk). Women who started more than 10 years after menopause saw no benefit. Second, the benefit was strongest among Black women - roughly half the risk - which is notable because hot flashes and night sweats tend to be more frequent and more severe in Black women.
Some context you deserve: in the early 2000s, the Women's Health Initiative trials raised alarms about hormone therapy and the heart, and a generation of women and doctors backed away from it. Much of that fear came from studying women who started hormones well past menopause. The FDA recently removed the broad black box warnings from these products, and this is the first US study of its kind to look at heart outcomes in women who start therapy during perimenopause or early postmenopause - which is when most women actually need it.
What you gain from this
First, honest context: this is an observational study, so it shows an association, not proof. An editorial in the same journal, from Mayo Clinic researchers, cautions that women who choose hormone therapy often differ from non-users in other healthy behaviors - that "healthy user bias" can flatter the results. The study's own authors are clear: these findings do not support using hormone therapy to prevent heart disease, and longer use still carries a real breast cancer risk that must be weighed.
Second, meaning: if you are in perimenopause or early menopause with hot flashes or night sweats that disrupt your sleep, your work, your life - this study is reassuring on the heart question. It does not say hormone therapy protects your heart. It says that starting it at the right time, for the right reason, was not linked to the cardiac harm many women still fear.
Third, action: if you have been white-knuckling through hot flashes because of headlines from twenty years ago, bring this study to your doctor. Timing is part of the conversation now, and the window matters. And if you are a Black woman reading this, the data here speak to you directly.
Sources: Wang Z, et al. JAMA Internal Medicine (2026), https://doi.org/10.1001/jamainternmed.2026.2922 - with editorial, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2853616
That's the pattern here: the research, the plain-English meaning, and what to do with it. See you next time.
Dr. Herman Weiss
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