If hot flashes have stretched on for years and old warnings made you wary, the latest findings give you better questions to bring to your doctor.
By EEW Magazine Online Editors
Boston Globe columnist Kimberly Atkins Stohr wrote in 2025 about starting hormone therapy after years of asking doctors about her symptoms. (ourtesy of Kimberly Atkins Stohr)
Kimberly Atkins Stohr was at a live podcast taping in Washington in May 2023 when the heat came over her. She had turned 50 that year and had been living with night sweats, fatigue and trouble concentrating. For years, she later wrote, she had asked her gynecologist whether perimenopause could explain her symptoms and was told it was too soon.
A co-host pointed her toward a menopause specialist, who talked her through her options. She started hormone therapy, and the brain fog and drenching nights eased.
Stohr, a Boston Globe columnist, told that story in a 2025 column urging Black women to "demand the treatment they deserve." Two studies released this fall speak to a fear that keeps many women from asking: that hormones will hurt the heart.
The first, published Sept. 8 in JAMA Internal Medicine, followed 2,737 U.S. women who had hot flashes or night sweats and no history of heart trouble. Those who started hormone therapy in perimenopause or soon after menopause had an estimated 22% lower risk of heart attack, stroke and related events than those who did not, researchers at Virginia Commonwealth University and the University of Pittsburgh reported.
Among Black women the difference was larger, an estimated 49% lower risk. Women who began within 10 years of menopause had a 27% lower risk. Those who started later showed no clear benefit, and neither did white women or the other groups analyzed separately.
Those percentages compare one group with another. In raw numbers, the gap came to about three fewer cases per 1,000 women after five years and nine fewer after 10, according to the published paper.
Hormone therapy and the heart
Estimated drop in heart risk with hormone therapy
Women with hot flashes or night sweats who started hormone therapy near menopause, compared with similar women who did not.
Source: JAMA Internal Medicine, Sept. 8, 2026. Study of 2,737 U.S. women over 20 years.
The same finding in raw numbers
Each dot is one woman out of 1,000. Black dots show the estimated heart events avoided among women who started hormone therapy.
Source: JAMA Internal Medicine, Sept. 8, 2026.
Menopause before 40 is more common among Black women
Share of women whose natural menopause came before age 40. It was associated with about 40% higher lifetime risk of coronary heart disease.
Black women veterans' odds of a hormone therapy prescription
26% lower
compared with white women veterans, in a study of more than 200,000 women in VA care
Sources: Northwestern Medicine, JAMA Cardiology, March 2026; Menopause, July 2022.
These studies observed women over time and cannot prove that hormone therapy caused the difference. Researchers say it should not be started to protect the heart. Talk with your doctor about your own health history.
The study has limits. It observed women's own choices over two decades and did not assign treatment, so it cannot prove the hormones caused the difference. Women who take hormone therapy tend to differ from those who do not in income and access to care.
The authors said the results do not support taking hormones to protect the heart, and they noted that longer use is tied to a higher risk of breast cancer. Rebecca Thurston of the University of Pittsburgh, a senior author, cautioned that the findings should not guide clinical practice.
The second study, presented this month at the American Heart Association's Scientific Sessions in Chicago, examined records for 52,330 women ages 45 to 59 in Israel over an average of 12 years. Rates of heart attack, stroke and blood clots were similar among women who started hormone therapy and those who did not, according to the association's summary.
Those findings are preliminary and have not been peer reviewed. They come from Israeli health records, so they cannot speak directly to Black American women.
The studies follow a change in federal labeling. In November 2025, the Food and Drug Administration said it would remove boxed warnings about heart disease, breast cancer and dementia that had appeared on these drugs for more than two decades. It approved the first updated labels, for six products, in February.
Those risks are still described elsewhere in the labeling. A boxed warning about endometrial cancer remains on estrogen-only products that act throughout the body.
Randomized trials still point to risks that differ by regimen. A Cochrane review updated in September concluded that combined estrogen and progestogen therapy probably raises the risk of breast cancer, and that estrogen-only therapy probably raises the risk of stroke. The new studies do not show that every form of hormone therapy is equally safe for every woman.
For Black women, the question presses on several fronts. In the long-running Study of Women's Health Across the Nation, they were 50% more likely than white women to report hot flashes, University of Michigan researchers found.
Menopause before age 40 was associated with about 40% higher lifetime risk of coronary heart disease in a Northwestern Medicine study published in March. It was three times as common among Black women as white women, 15.5% compared with 4.8%.
Black women are also treated less often. In a study of more than 200,000 women veterans in the Veterans Health Administration, they had 26% lower odds than white women of being prescribed systemic hormone therapy.
Hormone therapy is not right for everyone. The Menopause Society holds that benefits outweigh risks for women younger than 60, or within 10 years of menopause, who have no medical reason to avoid it, according to an American Family Physician editorial. Harvard Health advises women to review their own history with a doctor, including any heart attack, stroke, blood clot, hormone-sensitive cancer or liver disease.
The research points to questions worth bringing to an appointment. A woman can ask whether hot flashes or night sweats that disrupt her days warrant treatment, and whether the timing is right given how long it has been since menopause began. She can also ask what nonhormonal options exist.
For a woman whose periods ended before 40, Dr. Priya Freaney, the Northwestern cardiologist who led the March study, suggested saying so directly: "I experienced premature menopause. What can we do to protect my heart?"
Stohr wrote that she wished she had pressed for answers years earlier.
