Two major reviews published in 2026, one in the European Heart Journal Open and one in Frontiers in Reproductive Health, conclude that women who start hormone therapy within 10 years of menopause may see cardiovascular benefits rather than harm.
That finding reverses the assumption that drove millions of women off the treatment after the 2002 Women's Health Initiative trial.
The reviews describe timing as the decisive variable. Women who start close to menopause, or before age 60, show improved cardiovascular outcomes. Starting a decade or more after menopause is linked to a higher risk of stroke and blood clots.
Where the WHI fear came from
The 2002 Women's Health Initiative trial enrolled tens of thousands of postmenopausal women aged 50 to 79. It was stopped early because of increased risks of breast cancer, coronary heart disease, stroke and pulmonary embolism in women taking oral conjugated equine estrogen plus medroxyprogesterone.
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Prescriptions collapsed almost overnight, and a generation of doctors and patients treated hormone therapy as unsafe.
Later analyses showed the risk was strongly age-dependent. Women who started in their fifties did not share the excess risk seen in women in their sixties and seventies. Most of those older participants had joined the trial long after their last period.
Why transdermal delivery matters
The European Heart Journal Open review notes that oral synthetic hormones and skin-based formulations do not behave the same way in the body.
A Swedish register study it cites found that oral continuous combined therapy was linked to a modest increase in ischemic heart disease. Transdermal estrogen was not associated with a significant rise in cardiovascular risk.
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The Frontiers review adds a mechanism. Transdermal estradiol bypasses the liver's first-pass metabolism, which the authors say helps avoid the clotting changes that oral estrogen can drive. Higher-dose patches still carry more risk than lower doses.
What regulators now say
On November 10, 2025, the U.S. Food and Drug Administration announced it would remove the black box warning from estrogen-containing hormone therapy products, citing outdated interpretations of the WHI data.
The revised labels are expected to carry age-specific guidance that hormone therapy started within 10 years of menopause may bring long-term health benefits. The warning for endometrial cancer on estrogen-only products stays in place.
The Menopause Society backed the change.
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In its response, the society said, "The risks are low for younger, healthy women initiating hormone therapy closer to the menopause transition. Risks are greater when initiated in older women and in those who are further from menopause onset."
None of this makes hormone therapy right for every woman. Personal and family history of breast cancer, blood clots, stroke and heart disease still shape the decision, and both reviews argue for individualized assessment.
Women weighing hormone therapy, or who stopped taking it after the WHI scare, should talk with their doctor about their own risk profile.
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