Modern menopause hormone therapy not tied to more heart attacks or strokes

Modern menopause hormone therapy, often called HRT (hormone replacement therapy), was not linked to more heart attacks, strokes, blood clots or deaths in a long-term study of more than 52,000 women in Israel aged 45 to 59.¹ The findings are preliminary and will be presented at the American Heart Association’s Scientific Sessions 2026, held Nov. 6–9 in Chicago.¹

Fear for the heart is a big reason many women turn down hormone therapy for hot flashes and other menopause symptoms, according to the study’s lead researcher, Ronen Arbel, of Clalit Health Services in Tel Aviv and Sapir College’s Maximizing Health Outcomes Research Lab.¹ He said the same worry makes some doctors hesitate to offer it.¹

What the researchers did

The team used health records from Clalit Health Services, a large Israeli health provider.¹ They looked at 52,330 women aged 45 to 59 who had no history of heart disease, blood clots or cancer.¹ Half of them had started hormone therapy, mostly as pills, skin patches, or both.¹ The other half had recently seen a gynecologist but did not start hormone therapy, and they did not take it at any point during the study.¹

To make the two groups as alike as possible, the researchers matched women by age, body mass index (a measure of weight for height), blood pressure, cholesterol, diabetes, smoking and income level.¹ They then followed the women’s records for up to 23 years, 12 years on average.¹ They counted heart attacks, strokes and related heart and artery disease, blood clots in the veins, and death from any cause before age 80.¹

The numbers

The two groups ended up with very similar results:¹

• Heart attack, stroke or related heart disease: 2,311 women (4.4%) in the hormone therapy group, compared with 2,383 (4.6%) in the group without it.¹
• Death before age 80: 659 women (1.3%) taking hormone therapy, compared with 653 (1.2%) not taking it.¹
• Blood clots: 0.33% in both groups, which was 174 women with hormone therapy and 175 without.¹

The researchers said the results were similar no matter what form the hormones came in, whether pills, patches or gels.¹ “Our results indicate that, for women in their mid-40s to late 50s with no history of heart disease or blood clots, the currently available hormone therapies prescribed to manage menopause symptoms do not appear to raise the risk of heart attack, stroke, clots or early death, even after long-term use,” Arbel said.¹

What it does not show yet

This is an observational study. It looked back at what happened to women who made their own choices, rather than randomly assigning some women to hormone therapy and others to a dummy pill. The research summary states plainly that an observational study cannot prove a direct connection between hormone therapy and heart health.¹ The researchers also noted there may be other differences between the two groups that the matching did not capture.¹ For example, women who choose hormone therapy might differ in health habits or in how often they see a doctor.

The work has not yet been published in a peer-reviewed journal; the American Heart Association described it as preliminary research ahead of its meeting.¹ Conference findings can change once full data are checked by outside experts.

The results also apply to a specific group: women aged 45 to 59 with no past heart disease, clots or cancer.¹ They say nothing direct about women who start hormones later in life, or about women who already have heart problems.

Who is behind it

The study was run by researchers at Clalit Health Services and Sapir College in Israel.¹ The American Heart Association called it independent research.¹ The available summary does not name any drug company funding.

Stacey E. Rosen, a women’s heart health expert at Northwell Health in New York and a past volunteer president of the American Heart Association, was not involved in the study.¹ She said it “adds to growing evidence that today’s hormone therapy options may not increase the risk of heart disease, stroke or blood clots for healthy women who begin treatment around the time of menopause.”¹

How it fits with other research

Earlier randomized trials, where women were assigned hormones or not by chance, had found links between hormone therapy and heart harm.¹ But those results were mixed, and much of that evidence came from older hormone products that are rarely used now, higher doses, and women who started therapy long after menopause.¹ Current guidelines from the American College of Obstetricians and Gynecologists recommend starting hormone therapy within 10 years of menopause and before age 60.¹ In November 2025, the FDA removed its strongest “black box” warnings from hormone therapy products after reviewing current scientific data.¹

Not every recent study points in exactly the same direction. A large Swedish study published in the BMJ in 2024 used national records to compare women aged 50 to 58 who did and did not start hormone therapy.² It found that the type and form of hormones mattered. Estrogen combined with a progestin (a man-made form of the hormone progesterone), taken as pills, was linked to a higher risk of blood clots in the veins.² Another drug, tibolone, was linked to more heart disease.² Hormones taken through the skin were not linked to a higher risk of heart disease.² The Swedish authors suggested that estrogen swallowed as a pill passes through the liver, where clotting proteins are made, while estrogen absorbed through the skin largely skips that step.²

That contrasts with the new Israeli result, where clot rates were the same in both groups and results were similar across pills, patches and gels.¹ The two studies used different populations and methods, so readers will see both findings in the debate until fuller data are published.

Separate research has looked at menopause timing itself. A study in JAMA Cardiology in March 2026 found that women whose natural menopause came before age 40 had about a 40% higher lifetime risk of coronary heart disease than women whose menopause came later.³ A review of 36 studies covering more than 2.6 million women, published in JAMA Network Open, found higher heart risk after menopause caused by surgery or medical treatment, especially in women younger than 45.⁴ That review could not judge whether hormone therapy lowers that risk, and its authors called this a priority gap in the evidence.⁴

What to watch next

• The full presentation: the study will be presented at the American Heart Association meeting in Chicago, Nov. 6–9, which may bring more detail on methods and limits.¹
• A journal paper: peer review would let outside experts check how well the matching worked and whether other differences between the groups could explain the results.
• Different forms of hormones: whether pills carry more clot risk than patches, as the Swedish data suggested, remains an open question that more studies may address.²
• Women at higher risk: the open questions about early or surgical menopause, and whether hormone therapy changes heart risk for those women, are still unanswered.⁴

Rosen said findings like these can help women and their health care teams have more informed conversations about benefits and risks based on each woman’s health needs.¹ This article is news, not medical advice.