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Purpose of Review <p>Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor and genitourinary symptoms of menopause, yet its role in cardiovascular prevention has been the subject of significant debate.</p> Recent Findings <p>Early observational studies suggested cardioprotective effects, but large randomized trials subsequently demonstrated no cardiovascular benefit and, in some cases, potential harm. These findings led to a sharp decline in MHT use. Emerging evidence supports the “timing hypothesis,” where MHT is safe in healthy women younger than 60&#xa0;years of age and/or within 10&#xa0;years postmenopause.</p> Summary <p>Guidelines recommend avoidance among women at high cardiovascular risk and a cautious, individualized approach for those at intermediate risk. Importantly, MHT is not recommended for either the primary or secondary prevention of cardiovascular disease. Future research must focus on improving cardiovascular risk stratification in midlife women, particularly with novel biomarkers and risk calculators, elucidating the connection between vasomotor symptoms and CVD, and developing trials comparing the efficacy and safety of contemporary MHT formulations among younger, more recently menopausal women.</p>

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Matters of the Heart: Menopause, Hormones, and Cardiovascular Disease

  • 期刊论文

  • 发表日期：

    2025年12月3日

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  • Ruby Guo,
  • Emily S. Lau

摘要

Purpose of Review

Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor and genitourinary symptoms of menopause, yet its role in cardiovascular prevention has been the subject of significant debate.

Recent Findings

Early observational studies suggested cardioprotective effects, but large randomized trials subsequently demonstrated no cardiovascular benefit and, in some cases, potential harm. These findings led to a sharp decline in MHT use. Emerging evidence supports the “timing hypothesis,” where MHT is safe in healthy women younger than 60 years of age and/or within 10 years postmenopause.

Summary

Guidelines recommend avoidance among women at high cardiovascular risk and a cautious, individualized approach for those at intermediate risk. Importantly, MHT is not recommended for either the primary or secondary prevention of cardiovascular disease. Future research must focus on improving cardiovascular risk stratification in midlife women, particularly with novel biomarkers and risk calculators, elucidating the connection between vasomotor symptoms and CVD, and developing trials comparing the efficacy and safety of contemporary MHT formulations among younger, more recently menopausal women.