Deciding whether to use hormone therapy during menopause is often confusing.
Menopause marks the end of a woman’s reproductive years, and while some symptoms like hot flashes and night sweats are well known, it also brings a higher risk of heart problems.
Many women are unsure whether hormone therapy is safe, especially when it comes to their heart.
Now, new research led by Dr. Matthew Nudy at Penn State College of Medicine suggests that hormone therapy might actually be good for heart health—if used in the right way.
The study looked at women who were part of a large, long-term project called the Women’s Health Initiative (WHI). This program has tracked the health of post-menopausal women for many years. The researchers specifically studied how hormone therapy affected certain health markers linked to heart disease.
The team studied blood samples from nearly 2,700 women, taken over a period of six years. The women had been randomly assigned to one of two groups: one group received only estrogen, and the other received both estrogen and progesterone.
The goal was to see how hormone therapy changed things like cholesterol, blood sugar, and other substances in the blood that can affect heart health.
The results were promising. In both groups, the ‘bad’ cholesterol (LDL) dropped by about 11%, while ‘good’ cholesterol (HDL) went up—13% in the estrogen-only group and 7% in the group that got both hormones.
Total cholesterol and insulin resistance, a factor in diabetes and heart disease, also decreased. However, not all results were positive: triglycerides (a type of fat in the blood) and blood clotting factors increased, which may raise some concerns.
One of the most exciting discoveries involved a substance called lipoprotein(a), or Lp(a). This form of cholesterol is considered a strong genetic risk factor for heart attack and stroke, especially in younger adults.
It’s not affected much by diet or lifestyle, and currently, no FDA-approved drugs can lower it. But in this study, Lp(a) levels dropped by 15% in the estrogen-only group and by 20% in the estrogen-plus-progesterone group.
Dr. Nudy, a cardiologist, said this finding stood out the most. If hormone therapy can safely lower lipoprotein(a), it could become a valuable tool for preventing heart disease in certain women. The decrease in Lp(a) was especially strong among women with American Indian, Alaska Native, Asian, or Pacific Islander ancestry—though it’s unclear why.
The hormone used in the study was a specific type of oral estrogen made from horse-derived hormones (called conjugated equine estrogens). Because oral estrogen goes through the liver first, it can raise triglycerides and inflammation.
But Dr. Nudy pointed out that other forms of estrogen, like patches that go on the skin (transdermal estrogen), don’t seem to have these side effects.
So what does this mean for women going through menopause? While hormone therapy is not currently approved to prevent heart disease, this study adds to the growing evidence that, for certain women—especially those within 10 years of menopause and in generally good health—it may offer benefits beyond symptom relief.
Still, Nudy advises that anyone considering hormone therapy should get their heart health checked first.
This research brings new hope to the ongoing conversation about menopause and heart health. With more studies, we may soon have clearer answers—and possibly safer, more effective treatments for women in midlife.
If you care about heart health, please read studies that Manganese can help clear arterial plaques and treat heart disease and Aspirin use linked to heart failure.
For more about heart health, please read studies about the blood thinner drug that can prevent strokes in people with hidden heart issues and new guidelines on daily aspirin for heart attack and stroke prevention.
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