HRT & Cardiovascular Risk

Hormone Replacement Therapy (HRT) remains the most effective treatment for menopausal symptoms and is fundamentally linked to cardiovascular and overall long-term health when carefully tailored to the individual. The British Menopause Society (BMS) highlights that HRT can lower the risk of developing coronary heart disease and provide protective effects against osteoporosis and diabetes, especially when started under 60 or within ten years of menopause—the so-called “window of opportunity.” Early initiation during this window is associated with maximised heart and all-cause mortality benefits, whereas late initiation (over ten years post-menopause) is not.

For women over 60, BMS guidelines recommend a personalised, holistic review of ongoing HRT use, focusing on the lowest effective dose and encouraging the use of transdermal options (patches or gels) to reduce stroke or clot risk. Continuing HRT may be entirely appropriate for symptom control and bone protection, but it should be reviewed annually, accounting for evolving health risks and changing benefits. There is no fixed age at which HRT must be stopped; decisions about continuation should be made jointly, ensuring individual preferences and medical needs are prioritised, with regular discussions about risk, symptom management, and dosage adjustments.

Overall, BMS guidance emphasises that HRT use—regardless of age—should always be individualised, subject to annual review, and prescribed at the lowest effective dose.