A new study suggests that hormone therapy, often used to ease symptoms of menopause like hot flashes and night sweats, may also improve heart health over time.
The research was led by Dr. Matthew Nudy, a heart doctor and assistant professor at Penn State College of Medicine. The team analyzed data from the Women’s Health Initiative, a large national study that has followed many post-menopausal women for years.
The findings, published in the journal Obstetrics & Gynecology, showed that estrogen-based hormone therapy helped improve several markers related to heart health.
One of the most important discoveries was that it reduced levels of a harmful cholesterol-like substance called lipoprotein(a), which is known to raise the risk of heart attack and stroke. Lipoprotein(a) is mostly controlled by a person’s genes and is hard to lower through diet or exercise. There are currently no FDA-approved drugs that lower it.
Hormone therapy replaces the estrogen and progesterone that the body stops producing after menopause. There has been a lot of debate over the years about whether hormone therapy is safe, especially for the heart.
But this new research shows that it can be safe and even helpful for younger post-menopausal women—those within 10 years of starting menopause—who are generally healthy and don’t have heart disease.
During menopause, estrogen levels drop, and that can lead to changes in cholesterol levels, higher blood pressure, and buildup in blood vessels. All of these changes can increase the risk of heart disease. The research team wanted to see how hormone therapy affected heart health over a longer period, since earlier studies mostly looked at short-term results.
They looked at blood samples from 2,696 women who took part in a hormone therapy trial. Some women were given estrogen only, while others received a mix of estrogen and progesterone. They gave blood samples at the beginning of the study and then again after one, three, and six years.
Over time, the women on hormone therapy showed several improvements in heart health. “Bad” LDL cholesterol dropped by about 11%, and “good” HDL cholesterol increased by 13% in the estrogen-only group and 7% in the combination group. Total cholesterol and insulin resistance also decreased.
There were some increases in triglycerides and certain proteins that help with blood clotting, which may be a side effect of the way the hormone therapy is processed in the liver. The therapy used in the study was a common form of oral estrogen made from equine (horse-derived) sources, which is known to raise these markers.
Interestingly, lipoprotein(a) levels dropped by 15% in the estrogen-only group and 20% in the combination group. This was especially noticeable in women of American Indian or Alaska Native backgrounds (41% drop) and Asian or Pacific Islander backgrounds (38% drop), though researchers don’t yet know why the reductions were greater in these groups.
Dr. Nudy pointed out that newer forms of hormone therapy, such as skin patches (transdermal estrogen), may not raise triglycerides or clotting factors as much as oral pills do. These newer options could offer safer ways to treat menopause symptoms while also supporting heart health.
He recommends that women thinking about hormone therapy during menopause should get a heart health check, even if they haven’t had a heart attack or been diagnosed with heart disease. This can help doctors decide if hormone therapy is a good choice for them.
While hormone therapy is not currently approved by the FDA to lower the risk of heart disease or stroke, this study adds new information that could help guide future decisions and research.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
For more health information, please see recent studies about how to eat your way to cleaner arteries, and salt and heart health: does less really mean more?
The study findings can be found in Obstetrics & Gynecology.
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