--- title: "Modern HRT Did Not Raise Heart Attack or Stroke Risk in a 12-Year Study of 52,000 Women: What to Ask Your GP" description: Modern HRT did not raise heart attack, stroke or clot risk in 52,330 women aged 45 to 59. How it fits older warnings and what to ask your GP. author: Dr Marina Nani (Editor-in-Chief) date: 2026-11-05T08:00:00.106Z updated: 2026-11-05T08:00:00.115Z canonical: https://richhealthmagazine.com/article/hrt-heart-disease-risk image: https://cdn.nanimediahouse.com/pexels-12599544.webp categories: Health content_type: Guide region: United Kingdom publication: Rich Health Magazine schema_type: Article --- Worry about the heart is one of the most common reasons women turn down HRT, and one of the reasons some doctors hesitate to offer it. A study of 52,330 women, followed for an average of 12 years, now puts numbers on that worry. Women aged 45 to 59 who started modern hormone replacement therapy had no more heart attacks, strokes, blood clots or early deaths than women who did not. The findings will be presented at the [American Heart Association's Scientific Sessions](https://newsroom.heart.org/news/long-term-study-finds-modern-hormone-replacement-therapy-not-linked-to-heart-disease-risk) in Chicago, which run from 6th to 9th November. If you are weighing up HRT for hot flushes, broken sleep or low mood, this is what the new data shows and where it fits with the warnings you may have heard. ## Results of the Israeli HRT Study The study used health records from Israel. Half the women started HRT, mostly as tablets or patches. The other half had recently seen a gynaecologist but never started HRT. The two groups were matched on age, weight, blood pressure, cholesterol, diabetes, smoking and income, and followed for up to 23 years. - **Heart attack, stroke or related heart disease:** 2,311 women who started HRT (4.4%) against 2,383 who did not (4.6%). - **Blood clot:** 174 women who started HRT (0.33%) against 175 who did not (0.33%). - **Death before the age of 80:** 659 women who started HRT (1.3%) against 653 who did not (1.2%). The results were similar for tablets, patches and gels. None of the women had a history of heart disease, blood clots or cancer when they started. ## Why Older HRT Studies Warned About the Heart The fear of HRT dates back to large trials in the late 1990s and early 2000s. Those trials tested one older combination of hormones, and the women in them were in their sixties on average, a decade or more past the age most women start HRT today. Higher doses and formulations that are rarely prescribed now made up much of that early evidence. The official position has moved since. In November 2025 the US Food and Drug Administration removed the 'black box' warnings from HRT products after reviewing the evidence on heart disease, breast cancer and dementia. The [NHS](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) now describes the older view of HRT as out of date and says HRT has little or no effect on your risk of coronary heart disease. ## HRT Tablets Versus Patches and Gels The type of HRT you take still matters. A [2024 study of 919,614 Swedish women](https://www.bmj.com/content/387/bmj-2023-078784) aged 50 to 58 split HRT into eight types and found clear differences between them. - **Combined oestrogen and progestogen tablets** were linked to a higher risk of heart disease and blood clots. - **Tibolone**, a synthetic hormone tablet, was linked to a higher risk of heart disease, stroke and heart attack, but not blood clots. - **The size of the risk** was around 11 extra cases of heart disease for every 1,000 women who started combined continuous tablets or tibolone, over one year. The [NHS](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) gives similar advice. HRT tablets can slightly raise the risk of blood clots and stroke, though the risk is very low, particularly under 60. Patches, sprays and gels do not raise the risk of clots, as oestrogen absorbed through the skin is safer. The Swedish and Israeli findings can both hold true. The Swedish researchers measured risk in the first two years after starting and compared each type separately. The Israeli study grouped women by the first HRT they used and tracked them for 12 years on average. A small early rise with some tablets would not necessarily show up as a lasting difference across a decade, and the long follow-up is what makes the new figures reassuring. ## Who the New HRT Findings Apply To The results cover women aged 45 to 59 with no history of heart disease, blood clots or cancer. If that describes you, the data supports starting HRT around the time of menopause without fearing for your heart. The study has limits you should weigh. It is observational, so it shows a link and cannot prove cause. The records did not capture exercise, diet or how severe each woman's symptoms were, and women who changed HRT type during the study were counted under their first prescription. The findings are also preliminary: they come from a conference abstract that has not yet been peer reviewed or published as a full paper. If you already have heart disease, the picture is different. [British Menopause Society guidance](https://thebms.org.uk/wp-content/uploads/2026/06/22-NEW-BMS-TfC-Management-of-menopause-for-women-with-CVD-JUNE2026-A.pdf) treats HRT as usually high risk for women with known cardiovascular disease, a 10-year heart risk of 10% or more or uncontrolled risk factors such as high blood pressure. ## Menopause and Your Heart Health Menopause is itself a turning point for your heart. On 26th October, four US medical societies including the American Heart Association published [joint guidance](https://www.contemporaryobgyn.net/view/multi-society-framework-ties-cardiovascular-risk-female-life-stages) that organises heart prevention for women around four 'Female Life Stages', from puberty through menopause and beyond. Women who reach menopause before 45 face a significantly higher risk of coronary heart disease, which makes a heart check at that stage worth booking whether or not you choose HRT. For more on protecting your heart, bones and muscle from your forties, read our guide to [staying healthy for longer](https://richhealthmagazine.com/article/womens-longevity-7-ways-to-stay-healthy-for-longer). ## Questions to Ask Your GP About HRT Go into your appointment with these questions written down. - **Is a patch, gel or spray better for me than a tablet?** Skin-based oestrogen does not raise the risk of blood clots, which matters most if your GP rates your clot risk as higher than average. - **Which progestogen will I take, and in what form?** If you still have a womb, you need a progestogen alongside oestrogen, and the type and route vary. - **What is my heart risk score for the next decade?** Ask for your blood pressure and cholesterol to be checked so the score is up to date. - **Am I starting at the right time?** The NHS says that if you are under 60, have symptoms and are not at high risk of breast cancer or blood clots, the benefits of HRT are likely to outweigh the risks. - **When should we review it?** Regular reviews let you change the type or dose as your health changes. If symptoms are affecting your work, our guide to [getting menopause support at work](https://richhealthmagazine.com/article/menopause-at-work-support) covers treatment, workplace adjustments and the support UK employers now owe you.