Hormone therapy heart-safe for under 60s with menopause symptoms

Hormone therapy is safe for treating menopause symptoms such as hot flushes and night sweats in women aged 50–59, but should not be started after 70 due to cardiovascular risks, research shows.

The study analysed 20 years of data from over 27,000 women aged 50–79 with moderate to severe menopausal symptoms who received either treatment or placebo.

Women who began therapy between 50 and 59 showed no higher risk of heart disease compared with placebo.

In contrast, those over 70 faced substantially increased risk of atherosclerotic cardiovascular disease – a build-up of plaque in arteries that can lead to heart attacks and strokes.

Co-author JoAnn Manson is chief of the division of preventive medicine at Brigham and Women’s Hospital.

She said: “This paper has a very important message for clinicians and women considering HT use: HT is appropriate and has a favourable benefit: risk profile for treating hot flushes among women below age 60, but it’s important to avoid starting treatment after age 70 among women with hot flushes.

“Our findings support current HT guidelines but help to clarify that risk varies strongly by age.”

Researchers at Brigham and Women’s Hospital examined data from the Women’s Health Initiative trials, addressing long-standing fears about hormone therapy and heart safety.

The study is the first to look closely at links between hot flushes, hormone treatment and cardiovascular risk across different age groups.

Many women have avoided hormone therapy – used to ease hot flushes, night sweats and other symptoms – since earlier studies raised concerns about heart disease.

The new analysis showed clear age-related differences. Women starting treatment in their 50s had no added heart risks, while those beginning after 70 faced substantially higher danger.

Manson, a founding member of the Mass General Brigham healthcare system, is one of the principal investigators of the Women’s Health Initiative.

The findings offer guidance for treatment decisions during menopause, when falling oestrogen levels cause symptoms that can disrupt daily life. Hormone therapy replaces these hormones to reduce symptoms.

The heart safety profile differs sharply by age.

For women in their 50s, therapy carries no extra cardiovascular risk while easing symptoms. But beginning after 70 brings substantial risks, particularly of atherosclerotic disease.

The results support current clinical guidelines while adding clearer, age-specific evidence to help women and doctors make informed choices based on individual risk.

The distinction between age groups is key for treatment planning, offering reassurance to younger women considering therapy while warning against late initiation in older age.