02/22/2026
Hormone Therapy Is Not the Villain It Was Made Out to Be.
A 2025 secondary analysis of the Women’s Health Initiative looked specifically at women with vasomotor symptoms (hot flashes) and cardiovascular risk. And here’s what matters:
👉 Women ages 50–59 with moderate to severe symptoms had NO significant increase in atherosclerotic cardiovascular disease.
Hazard ratio 0.85 (estrogen alone) and 0.84 (estrogen + progestin). In other words? Neutral. 
👉 Women 60–69 also did not show a clear signal of harm.
Yes, estimates trended up slightly in one arm, but confidence intervals crossed 1.0. Not statistically significant. so stop saying starting after ten years post menopause is so so dangerous. Even with oral prempro up to age 69 it was not.
👉 The increased cardiovascular risk signal was seen in women 70 and older — and this group had very small numbers with vasomotor symptoms.
In the estrogen-alone trial, only 220 women age 70–79 had moderate/severe symptoms.
In the estrogen + progestin trial, only 172 women age 70–79 had moderate/severe symptoms. 
That’s fewer than 200 women in one arm — yet that age group often gets generalized to all hormone therapy conversations.
Let’s zoom out.
✨ Absolute risks in younger women were low.
✨ No increased all-cause mortality in women 50–59 with symptoms.
✨ Hormone therapy reduced moderate/severe hot flashes by ~41%. 
✨ The data supports guideline recommendations: initiate within 10 years of menopause or before age 60 and risk benefit discussion after age 69. This paper but actually suggests that “you can’t do it” because of significant risk is not as evidence based as you would think.
The original 2002 WHI headlines scared an entire generation.
But when you actually read the data:
• Age matters.
• Time since menopause matters.
• Baseline cardiovascular health matters.
• Absolute risk matters.
Hormone therapy is not “dangerous.”
It is a medical therapy with specific indications, timing considerations, and patient selection.
doi:10.1001/jamainternmed.2025.4510
