Hormone Therapy, Heart Health, and the Unwritten Rules of Female Medicine

We’ve been told for decades that hormone therapy was too dangerous. That estrogen was a risky fix for menopausal symptoms. That heart attacks and strokes were the inevitable trade-off for relief from hot flashes and sleepless nights.

It turns out, the truth is far more nuanced—and for many women, far more hopeful.

Recent research is reshaping what we thought we knew about hormone therapy (HT), menopause, and heart health. It reveals a powerful and long-overdue insight: for healthy, younger menopausal women, hormone therapy might actually reduce cardiovascular risk.

This isn’t just about hormones. It’s about the historical underfunding, misrepresentation, and overgeneralisation of female health in medicine. It’s about the consequences of basing public health policy on outdated studies that didn’t ask the right questions—or ask them at the right time.

And it’s about reclaiming our right to evidence-based care that centres our unique physiology, not fears rooted in male-dominated narratives.

The Myth of the "Dangerous" Hormone

Back in the early 2000s, findings from the Women’s Health Initiative (WHI)—then the largest clinical trial of hormone therapy—seemed to confirm everyone’s worst fears: increased risk of stroke, blood clots, and breast cancer.

Overnight, hormone therapy went from being hailed as a silver bullet to being cast as a silent killer. Prescriptions plummeted. So did trust.

But here’s what didn’t make headlines at the time: most participants in that study were already well past menopause—many over the age of 60. 

The study wasn’t focused on the very population that most often considers hormone therapy today: perimenopausal and newly menopausal women in their 40s and 50s, looking for relief and long-term protection.

That difference matters. A lot.

Newer analyses and follow-up studies—including those led by cardiologist Dr. Matthew Nudy—are bringing clarity. When hormone therapy is started within 10 years of menopause onset, and before age 60, the cardiovascular risks not only decrease—they may flip into actual benefits. Fewer heart attacks. Lower cholesterol. Potentially longer lives.

Estrogen: The Forgotten Protector

The truth is, estrogen doesn’t just regulate reproductive cycles. It plays a vital role in keeping our cardiovascular system healthy.

Estrogen helps blood vessels stay flexible and supports nitric oxide production, which keeps arteries open and blood pressure in check. It influences how our bodies process cholesterol, reducing the kind that builds up in artery walls. It calms inflammation and helps prevent the dangerous stiffening of blood vessels that can lead to heart disease.

So when estrogen drops—suddenly and sharply during menopause—the ripple effects are profound.

Add in the fact that heart disease is the number one killer of women globally, and you begin to see the scope of the issue: this isn’t just about symptoms like night sweats or mood swings. It’s about systemic, structural health outcomes that have been routinely ignored.

Route Matters. Timing Matters. You Matter.

One of the more shocking realisations from the last two decades of research is how much how you take hormone therapy impacts risk.

Estrogen pills must pass through the liver before entering the bloodstream—a process called “first-pass metabolism”—which increases the production of clotting factors and can raise the risk of blood clots or stroke.

By contrast, transdermal estrogen (patches, sprays, gels) bypasses the liver entirely. The risk of clots? Dramatically lower. This should be headline news—but too many women still aren’t told.

We also now know the importance of personaliasing treatment based on when therapy begins. The so-called “timing hypothesis” is now widely supported: starting HT soon after menopause (within a 10-year window) appears to be not only safe, but protective. Waiting too long, however, can bring different risks.

So Why Aren’t More Women Hearing This?

Because we’ve let old studies and old fears dominate the narrative for far too long. Because most research still treats women as a special case, not a standard. And because we live in a system that would rather silence complexity than re-educate doctors and reframe public health.

That stops now.

If you’re navigating menopause—or thinking about your long-term heart health—here’s what you need to know:

1. Hormone therapy is not one-size-fits-all. Your age, time since menopause, personal and family health history, and method of administration all shape your risk-benefit profile.

2. HT may offer heart protection—if started early and used appropriately. Especially for women under 60 and within 10 years of menopause onset.

3. Transdermal methods (like patches or sprays) may carry fewer cardiovascular risks than pills.

4. HT is not for everyone. It’s not recommended for women with existing heart disease, blood clots, certain cancers, or other specific conditions.

5. You deserve the full picture. Not fear-based medicine. Not gendered generalisations. Not medical gaslighting. Just facts, options, and the ability to choose what’s right for you.

   
   

The Future of Menopause Care Starts Here

The menopause revolution isn’t coming. It’s here. And it’s time the science caught up with the lived experience of millions of women whose symptoms, stories, and hearts have been ignored.

This is your body. Your heart. Your health. You deserve information that is honest, holistic, and rooted in respect.

We’re not here to sell estrogen. We’re here to demand a new standard—where female physiology is the starting point, not the variable.