A 12-year study of 52,000 women found that starting modern hormone therapy at 45 to 59 did not raise the risk of heart attack, stroke or blood clots

For more than two decades, many women going through menopause have avoided hormone therapy out of fear for their hearts, after a large US trial was stopped early in 2002. Researchers in Israel looked at what happens with today’s hormone therapy. They compared 26,165 women aged 45 to 59 who started hormone therapy with an equal number of similar women who did not, and followed both groups for an average of 12 years. They tracked heart attacks, strokes, blood clots and early deaths.

Women who started hormone therapy had no higher risk of heart attack, stroke, blood clots or death before age 80 than women who did not. Over the follow-up period, about 4.4% of women on hormone therapy had a heart attack, stroke or other cardiovascular event, compared with 4.6% of women who did not use it.

The therapy included pills, patches and gels, the forms most women use today. None of the women had heart disease when they started.

These are preliminary results. They were presented on November 2 at the American Heart Association’s Scientific Sessions 2026 as a research abstract, which has not yet gone through full peer review, and the numbers could change when the complete study is published.

The fear goes back to the Women’s Health Initiative trial, published in JAMA in 2002, which reported more heart attacks, strokes and blood clots among women taking a combined estrogen and progestin pill and was stopped early. Many of those women were in their 60s and 70s, years past menopause, and later analyses suggested that age and timing matter a great deal. In November 2025, the US Food and Drug Administration removed the black box warnings from hormone therapy products after reviewing newer evidence.

The new results do not settle every question. A large Danish study in The BMJ this autumn, which we covered at the time, found that hormone therapy pills were linked to more blood clots at every dose, while patches and gels were not. The Israeli abstract, which pooled pills, patches and gels, found no overall rise in clots. Differences in doses, timing and how the women were matched may explain part of the gap, and the full paper should show whether the type of therapy mattered.

The second finding is about who was studied. The researchers matched the two groups carefully on age, weight, blood pressure, cholesterol, diabetes, smoking and income, and followed some women for as long as 23 years. The reassuring result applies to women who start hormone therapy before 60 and have no history of heart disease.

Stacey Rosen, an expert in women’s heart health and past president of the American Heart Association, said the study adds to growing evidence that today’s hormone therapy options may not raise the risk of heart disease, stroke or blood clots for healthy women who begin treatment around menopause.

For women weighing hormone therapy for hot flashes, night sweats or sleep problems, the practical point is to discuss timing and form with a doctor, especially if blood clots run in the family. Heart health in women is increasingly seen as tied to life stages like menopause, as new guidance from four US medical groups recently set out.

There are limits to what this shows. The study is observational, so women who chose hormone therapy may have been healthier in ways the matching could not capture. It was conducted in Israel, and the results have not yet been peer-reviewed.

Source

Presented at the American Heart Association Scientific Sessions 2026, Abstract MDP0654. Not yet published in a peer-reviewed journal. Summary: American Heart Association news release

Also cited

Writing Group for the Women’s Health Initiative Investigators. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women.” JAMA, 2002.
DOI: 10.1001/jama.288.3.321