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Menopause hormone therapy may improve cardiovascular health outcomes, study suggests

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Hormone therapy started in peri- or early post-menopause was linked to a 22 per cent lower risk of cardiovascular events in women with vasomotor symptoms in a recent study.

The findings came from an observational analysis of 20 years of health data and do not show that hormone therapy caused the reduction in cardiovascular risk.

The association was strongest among Black women and women who started treatment within 10 years of menopause onset, although researchers cautioned that the findings should not guide clinical practice.

The study is the first of its kind in the US to assess the risk of future cardiovascular events among women with vasomotor symptoms who use hormone therapy during peri- and early postmenopause.

Samar R. El Khoudary, professor and chair of the Department of Epidemiology at the VCU School of Public Health and one of the study’s senior researchers, said: “The menopause transition represents a critical window for understanding how hormone therapy may relate to cardiovascular disease risk. Our findings suggest that timing of initiation may influence cardiovascular outcomes.”

The researchers stressed that the findings do not support using hormone therapy to prevent cardiovascular disease.

Potential benefits must also be weighed against risks, including the increased breast cancer risk observed with longer-term use.

The study was not a randomised controlled trial, the gold-standard method for testing biomedical treatments.

Rebecca C. Thurston, associate dean for Women’s Health Research at the University of Pittsburgh School of Medicine and one of the study’s senior researchers, said: “These findings point to women with vasomotor symptoms as those who may show cardiovascular benefit from hormone therapy initiated during the perimenopause and postmenopausal years.

“However, conclusions should be tempered by the observational nature of the study, and findings should not guide clinical practice.”

Vasomotor symptoms, meaning hot flushes and night sweats, affect up to 80 per cent of women during the menopause transition and last for an average of seven to ten years.

Their frequency and severity build through perimenopause and typically peak in early postmenopause.

Hormone therapy replaces oestrogen and progesterone that women’s bodies stop producing after menopause and is currently the most effective treatment for these symptoms.

Clinical trials led by the Women’s Health Initiative in the early 2000s raised concerns about hormone therapy’s impact on heart disease, stroke, breast cancer and other risks, leading to years of reluctance among patients and providers to use the treatment.

El Khoudary said: “Hot flashes and night sweats have a significant impact on a woman’s quality of life and ability to work productively.

“While hormone therapy is an effective treatment for these symptoms, questions have remained about its cardiovascular effects, particularly the importance of when treatment is initiated during the menopause transition.”

More recent research suggests the effects of hormone therapy on the heart and vascular system may vary by age and treatment timing, with women younger than 60 who start treatment closer to menopause onset having different levels of risk.

In 2026, the US Food and Drug Administration removed “black box” warnings from hormone therapy products, reflecting evolving evidence on the benefits and risks of treatment.

Researchers from Virginia Commonwealth University and the University of Pittsburgh analysed data from more than 2,700 women taking part in the Study of Women’s Health Across the Nation (SWAN).

The women reported vasomotor symptoms and had not previously experienced cardiovascular events.

Clinical data collected between 1997 and 2017 were used to examine whether women who started hormone therapy for vasomotor symptoms were more or less likely to experience stroke, congestive heart failure, heart attack or revascularisation procedures than women who did not start treatment.

El Khoudary said: “By using data from the SWAN study, we essentially were able to emulate a series of hypothetical clinical trials to gain a deeper understanding into how hormone therapy taken to mitigate vasomotor symptoms during peri- and early postmenopause influences cardiovascular risk over time.

“It allowed us to examine clinically meaningful cardiovascular disease events over long-term follow-up in a population and treatment window that has been challenging to study prospectively.”

Starting hormone therapy during peri- or early postmenopause was associated with an estimated 22 per cent lower risk of cardiovascular disease events.

Women who began hormone therapy within 10 years of menopause onset had an estimated 27 per cent lower risk compared with women who did not start treatment.

Among Black women, starting therapy during peri- or early postmenopause was associated with an estimated 49 per cent lower risk of cardiovascular disease events.

No clear reduction was seen among women who started therapy more than 10 years after menopause onset or among White women and other racial and ethnic groups.

El Khoudary said: “The differences in cardiovascular outcomes by race and ethnicity are notable, particularly because Black women are more likely to experience severe vasomotor symptoms.

“These findings highlight the need to better understand how hormone therapy timing may influence cardiovascular outcomes across diverse populations.”

It remains unclear why cardiovascular risk differed according to when hormone therapy was started, although researchers believe differences in blood vessel health with age may play a role.

Menopause

Cancer drug could tackle osteoporosis menopause weight gain

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An experimental cancer drug reduced bone loss and body fat in mice modelling post-menopausal changes, early research suggests.

The compound, CADD522, appeared to strengthen bones and help the animals stay leaner after surgery designed to mimic hormonal changes seen after menopause.

The treatment remains at an early experimental stage and has so far only been tested in animals.

The study, led by the University of East Anglia, investigated CADD522, which was originally developed to block a protein involved in the growth and spread of several cancers.

Mice treated with the compound for eight weeks showed significant improvements in bone health. Scans found increased bone volume and better preservation of the honeycomb-like structures inside bones that are crucial for strength and resilience.

Blood tests suggested the treatment stimulated new bone growth without interfering with the body’s normal process of breaking down and rebuilding bone.

Dr Darrell Green, lead researcher from UEA’s Norwich Medical School, said: “Osteoporosis affects around one in three women over the age of 50, leaving sufferers vulnerable to painful fractures that can seriously impact quality of life.

“Current treatments exist, but many are plagued by side effects, safety concerns or inconvenient dosing schedules that make long-term use difficult.”

The researchers also found that mice receiving CADD522 weighed less than untreated mice despite eating the same amount of food.

They had less body fat and fewer fat deposits in their bone marrow, a process commonly seen after menopause and linked to declining bone health.

The team also examined brain tissue and found that the drug appeared to reverse several menopause-related changes in fatty acids.

Levels of omega-3 fats including DHA remained largely intact, while several other lipid abnormalities shifted back towards healthier patterns.

Green said: “We didn’t directly test for memory or thinking ability, but our work raises questions about whether this drug could one day help address wider menopause-related health problems.”

Safety experiments in mice, rats and dogs found that CADD522 could be taken orally and was well tolerated.

The compound also appeared to be metabolised more slowly in human tissue than in rodents, potentially improving its performance in people.

“This is still in the early stages and has so far only been tested in animals but we hope that the benefits will translate to humans to ultimately reduce fracture rates,” added Green.

The research was led by UEA in collaboration with the University of Maryland, the Scintillon Research Institute in San Diego and the University of Stirling.

Safety testing was funded by The Sir William Coxen Trust as part of the development of CADD522 as a childhood cancer treatment.

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Menopause hormone treatment may ease brain fog, study suggests

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Estriol treatment may ease menopause brain fog and other cognitive symptoms, according to a small observational study of 20 menopausal women.

The study involved menopausal women with an average age of 53.

They underwent an initial assessment of their cognitive symptoms before receiving a customised regimen of estriol and progesterone for 12 months.

Estriol is a natural form of oestrogen that occurs during pregnancy and has been used in Europe and Asia to treat menopausal symptoms including hot flushes and genitourinary symptoms.

It differs from estradiol, the most commonly used oestrogen hormone therapy in the US, by binding primarily to a different oestrogen receptor in the brain.

Previous research has shown that estriol may help protect brain cells and reduce brain atrophy in the hippocampus, the region responsible for learning and memory.

After 12 months of treatment, participants reported significant reductions in brain fog, concentration problems, working memory problems, slower processing speed, verbal memory problems and problem-solving difficulties compared with before treatment.

Senior author Dr Rhonda Voskuhl, a neurologist and member of the Comprehensive Menopause Center at UCLA Health, said: “Oestrogen plays a well-documented role in protecting the brain, yet there are still no approved type and dose of treatment that specifically targets the cognitive symptoms so many women experience during menopause.

“Women are often told to simply live with brain fog, when in fact there is a neuroscience basis for it, and potentially a way to address it. That gap in care is what motivated us to look more closely at estriol.”

Researchers also examined estriol treatment in midlife female mice to investigate how the hormone treatment might work.

Estriol reduced markers of brain pathology in the hippocampus and improved measures of working and spatial memory in the animals.

The findings are preliminary. The study was a small case series with no placebo group or randomisation, meaning the results may not apply to broader populations.

The researchers said larger placebo-controlled clinical trials using brain imaging and standardised cognitive testing are needed to confirm the findings on cognitive symptoms.

The treatment used in the study was invented by Voskuhl and is patented by UCLA. UCLA licenses the patent to CleopatraRX, which sells the treatment as PearlPAK. Voskuhl serves as a medical adviser to CleopatraRX.

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Deaf women “excluded” from menstrual health conversations at UK unis

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Deaf women face barriers to menstrual health information and support at UK universities, according to a study involving 12 BSL users.

Researchers believe it is the first study of its kind.

Participants described difficulties discussing sensitive health issues because universities and healthcare services often rely on hearing-centred communication systems.

The study was led by Professor Jemina Napier from Heriot-Watt’s School of Social Sciences and involved interviews and co-design workshops with 12 deaf women who use British Sign Language (BSL) and work or study in UK universities.

Napier said: “Our findings show that deaf women face many of the same menstrual health challenges as hearing women, but they also encounter additional barriers because information and support are rarely designed around their language and communication needs.

“The burden of constantly adapting to hearing-centred systems can leave deaf women feeling excluded from conversations about their own health.”

Participants reported a lack of accessible information about menstruation, endometriosis, fibroids, perimenopause and menopause, despite working in highly educated environments.

They also reported feeling excluded from informal conversations where hearing colleagues often share experiences and learn about menstrual health.

Researchers identified four main issues affecting participants: communication, access to information, interpreter dynamics and factors including ethnicity, geography and additional disabilities.

Many participants said they preferred discussing menstrual health directly in BSL but rarely had that opportunity because managers and healthcare professionals did not sign.

Instead, they often communicated through interpreters or written English, which some said reduced privacy, comfort and confidence when discussing personal health issues.

Napier said: “A recurring theme was that of the ‘deaf tax’, which refers to the additional emotional and practical effort deaf women need to continually undertake to explain their needs or secure support.

“It’s ongoing emotional labour and fatigue and reduced participation in menstrual-health related activities.”

BSL interpreters were seen as essential, but participants said their involvement could raise concerns about confidentiality, trust and accuracy, particularly when discussing sensitive topics.

Several highlighted that male interpreters appeared uncomfortable discussing menstrual health.

The researchers also found that existing menstrual health information is largely produced in English and then translated into BSL, rather than being created in BSL from the outset.

Abigail Gorman, deaf independent facilitator, health policy consultant and co-author of the report, said: “To be in charge of your own health, you need to be able to recognise when something’s wrong, name it, and ask for help – in an appointment where you can actually be understood. That’s the whole chain.

“But if the information was never accessible in the first place, deaf women can’t even get to step one. If the appointment itself isn’t accessible either, that breaks the chain all over again, when it matters most.

“BSL-first health resources aren’t a nice-to-have; they’re how deaf women get to be equal participants in decisions about our own health.”

Napier said: “The deaf women we interviewed want more visual, culturally appropriate resources designed specifically for them – not a crude translation of existing material.

“BSL accessibility should be the default for menstrual health information and events.

“We need improved interpreter policies and BSL-first educational resources.

“The university sector should also establish a UK-wide, deaf-led health and wellbeing network.

“All these changes would reduce communication barriers and improve access to menstrual health support for deaf women working in higher education.”

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