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HRT and Your Heart: What Two New Studies Say About Timing, Pills vs. Patches, and Race

September 28, 2026•10 min read

Quick answer: Two large studies published in September 2026 give us a clearer — and more specific — picture of how hormone therapy (HRT) affects your heart. A study of more than 2,700 midlife women found that starting HRT within 10 years of menopause was linked to roughly a quarter fewer heart-related events, and the benefit looked strongest in Black women. A separate Danish study found that estrogen taken as a pill slightly raises the risk of blood clots, while estrogen delivered through the skin — a patch, gel or spray — did not. None of this makes HRT a heart treatment — the researchers cautioned against using the findings to support HRT for heart disease prevention. What it does tell us is that when you start and which form you use both matter.

If you've spent years hearing that HRT is "bad for your heart," only to see headlines swing the other way, you're not imagining the whiplash. In November 2025 the FDA announced it was moving to remove the boxed warnings from HRT labels — a change our earlier post covers in detail (according to Healio, label changes for six HRT products were approved in February 2026). Since then, two new studies have landed, each looking at the heart question from a different angle. This post is a companion to our HRT for Menopause, What the Research Says Now article — here we zoom in specifically on your heart.

A woman in midlife rests her hand lightly over her chest with a calm, reassured expression, in soft natural light.

Why your heart is part of the HRT conversation

For more than 20 years, this question has been shaped by one big research program: the Women's Health Initiative (WHI). In July 2002, according to a U.S. National Heart, Lung, and Blood Institute announcement, one of its hormone trials was stopped early because of an increase in breast cancer, along with more heart disease, stroke and blood clots in the women taking estrogen plus progestin. The news scared many women and clinicians away from HRT for years.

Later, researchers noted that women in the trials averaged more than a decade past menopause, while women in earlier observational studies typically started closer to it. That idea became known as the "timing hypothesis": the effect HRT has on your heart may depend on when you start it. The two 2026 studies are the latest — and among the strongest — evidence on that question.

Timing matters: what the SWAN study found

The first study, published in JAMA Internal Medicine, drew on 20 years of data from the Study of Women's Health Across the Nation (SWAN), one of the longest-running studies of the menopause transition. Researchers looked at 2,737 women who had hot flashes or night sweats and were free of heart disease at the start. Over the next two decades, 755 of them started hormone therapy.

The headline: overall, women who started HRT had about a 22% lower chance of a heart-related event — a fatal or nonfatal cardiovascular event such as a heart attack or stroke — than similar women who didn't start. That's roughly one in five fewer events.

Timing sharpened the picture. Among women who started within 10 years of their last period, the reduction was about 27%. Among those who started more than 10 years after menopause, the result leaned the other way — toward a possible increase in risk — but was too uncertain to draw any conclusion.

"Our findings suggest that timing of initiation may influence cardiovascular outcomes," said Samar R. El Khoudary, PhD, a SWAN investigator and one of the senior researchers who led the study.

An important caution: HRT is not a heart medicine

Before you read "22% lower risk" and think of HRT as a way to protect your heart, slow down.

First, this was not a randomized trial — the kind that randomly assigns people to a treatment, the strongest way to prove cause and effect. The researchers matched women who started HRT with similar women who didn't, but they were still observing real-world patterns. Their paper says "all estimates warrant caution given the potential for residual confounding" — meaning other differences between the women could be partly responsible.

Second, and most important: the authors caution against using these results to support HRT as a way to prevent heart disease. HRT is prescribed to relieve symptoms, not to protect your heart. If your only reason for considering HRT is your heart, that's the wrong reason.

Race matters, too — and why the benefit looked strongest in Black women

One of the more striking findings was that the heart benefit wasn't the same across racial and ethnic groups.

Among Black women, starting HRT during perimenopause or early postmenopause was linked to roughly a 49% lower chance of a heart event — about half. The study did not find a clear benefit among White women or women of other racial or ethnic backgrounds. One of the senior researchers called the difference "notable," particularly because Black women are more likely to experience severe hot flashes and night sweats.

Why the difference? The study doesn't answer that. It's a question for future research, not a conclusion we can draw today. But if you're a Black woman with bothersome hot flashes, this is a finding worth raising at your next visit.

A woman in midlife talks with a female clinician in a bright, calm consultation room.

Pills vs. patches: what the Danish study found

The second study, published in The BMJ, asked a different question: does the form of HRT change the risk? Using national health records for women aged 50 to 69 in Denmark, researchers compared women who used HRT with women of the same age who didn't, across three outcomes: blood clots (in the legs or lungs), stroke, and heart attack.

The short version: the form mattered a lot.

For estrogen taken as a pill (alone or combined with a progestogen), the risk of a blood clot was about 60% higher than for non-users — and this held regardless of the dose or how long it was used. In absolute terms, that's about one extra blood clot for every 1,055 women taking oral HRT for a year. The increases in stroke and heart attack were smaller and, notably, only showed up with high-dose oral estrogen (more than 1 mg a day) used for more than a year — about one extra stroke for every 1,642 women per year, and one extra heart attack for every 3,846.

For estrogen delivered through the skin — a patch, gel, or spray — the picture was different. Transdermal HRT was not linked to a higher risk of blood clots, stroke, or heart attack, regardless of dose or duration. (There was one narrow exception: a particular combined transdermal regimen showed a higher heart-attack signal, based on a small number of cases.)

The takeaway isn't "pills are dangerous and patches are perfectly safe." It's that the route of delivery — and the dose — are part of the risk picture. As Amani Meaidi, MD, PhD, the study's senior author, wrote in an accompanying editorial (as reported by TCTMD): "These findings do not support describing menopausal hormone therapy as simply safe or unsafe." She added that "risk may depend on the therapy prescribed, the method of use, the dosage, and duration of treatment."

A transdermal HRT patch and a small pill bottle rest on a clean bedside table in soft morning light.

What else could it be?

Heart symptoms and hot flashes can have more than one cause — and that's why the "whole picture" matters.

Hot flashes and night sweats aren't always menopause — they can also come from thyroid problems, certain medications, infections, or other conditions. JoAnn Manson, MD, a lead WHI investigator, told TCTMD: "Sometimes those symptoms of hot flashes and night sweats are not specifically due to menopause." Talk with your clinician about what could be behind yours.

On the heart side, palpitations, shortness of breath, or chest discomfort during midlife deserve a real workup, not an assumption that they're "just menopause." If something feels off, the right move is to get it checked — not to guess.

Questions to ask your clinician

Based on my age and how long it's been since menopause, where do I fall in the "timing" picture these studies describe?
If I use HRT, would a patch, gel or spray be a better fit for me than a pill, given my personal clot and heart history?
What dose would be right for me, and how long do you typically recommend using it?
Do my hot flashes and night sweats look like they're from menopause, or should we rule out thyroid or other causes first?
What is my overall heart risk, and how does that change the way we think about HRT for my symptoms?

Frequently asked questions

Does HRT protect your heart?

No — and that's important. The SWAN study found women who started HRT within 10 years of menopause had a lower chance of heart events, but it was observational, and the authors cautioned against using the results to support HRT as a way to prevent heart disease. HRT is for relieving symptoms, not for heart protection.

Is HRT safe for your heart?

The honest answer is that it depends. The Danish study's lead message is that hormone therapy isn't simply safe or unsafe: risk may depend on the form, the dose, how long it's used, and your own history — especially any history of blood clots, stroke, or heart disease. That's a conversation for you and your clinician.

Are HRT pills worse for you than patches?

The 2026 Danish study found oral estrogen was linked to a higher risk of blood clots (and, at high doses used long-term, stroke and heart attack), while skin-delivered estrogen was not linked to higher clot or stroke risk. The form you use is worth discussing with your clinician.

Does HRT raise the risk of blood clots?

Oral estrogen was linked to a higher blood-clot risk in the Danish study — roughly one extra clot for every 1,055 women using it for a year — but estrogen delivered through the skin was not. If you have a personal or family history of blood clots, that's a key question to raise.

Why did the benefit look strongest in Black women?

The SWAN study found about a 49% lower chance of heart events among Black women who started HRT, but no clear benefit in White women or other groups. One senior researcher noted Black women are more likely to experience severe hot flashes, but the reason for the difference isn't established.

Ready for answers that fit?

Your heart and your hormones are connected in ways a one-size-fits-all message can't capture. The right next step is a conversation that looks at your whole picture — your symptoms, your timing, and your own heart risk. Take the free Whole-Picture Check — a short quiz that shows how your symptoms connect, so you can bring better questions to your next visit. Or get started with a licensed clinician who can help you weigh the options.

This article is for education only and isn't a substitute for individualized medical care. Hormone therapy carries different risks and benefits depending on your age, your time since menopause, the form and dose you use, and your personal and family medical history, and it requires a review with a clinician before starting or changing treatment.