Menopause, hormone treatment and cardiovascular risk: two new publications confirm and clarify their relationship!

Menopause is a natural biological phenomenon that marks the end of a woman's reproductive years. The ovaries stop working and producing essential hormones, mainly estrogen. This hormonal evolution has numerous consequences on health in general, particularly on cardiovascular function, fat metabolism, and vessel integrity. Estrogens have long been recognized as cardio-protective, with a lower incidence of cardiovascular disease in women than in men before the menopause.
Cardiovascular disease remains the leading cause of mortality among postmenopausal women. The decrease in estrogen after menopause leads to an increase in total cholesterol, a decrease in good cholesterol (HDL on your balance sheet), an increase in bad cholesterol that seeps into the artery wall (LDL on your balance sheet), a rise in blood pressure and insulin resistance. All these factors collectively contribute to an increased risk of cardiovascular disease. Despite the well-established association between menopause and metabolic changes, the direct impact of menopause per se on long-term cardiovascular risk remains unclear.
A study just published in the October 2025 issue of the journal Maturitas seeks to assess this specific role of menopausal status from a large prospective cohort in the UK (1). Data from 222,007 women were analyzed for a number of parameters, in particular their hormonal status. A high cardiovascular risk score was defined by a 10-year risk of stroke of over 7.5%.
In post-menopausal women (158,572), this risk was significantly higher compared to non-menopausal women (63,435).After adjustment for other known cardiovascular risk factors, menopause appeared to be an independent risk factor, particularly in women aged under 60.
This study therefore seems to confirm that menopause as such should be considered an independent cardiovascular risk factor. Global management is therefore essential, including a review of dietary hygiene rules and improved physical activity.
A second study was published this autumn in JAMA Internal Medicine (2), with a re-analysis of two randomized trials evaluating menopausal hormone therapy in US women aged 50 to 79 suffering from vasomotor symptoms. In this study, hormonal treatment combining an estrogen and a progestin reduced vasomotor symptoms of menopause without affecting cardiovascular risk in women aged 50 to 59. In contrast, in women over 70, the risk was increased in both trials.
These data confirm current recommendations to initiate hormonal treatment, if necessary due to climacteric symptoms, in recently menopausal women up to 10 years after the onset of menopause. On the other hand, later initiation increases the risk of cardiovascular events, and is therefore undesirable between the ages of 60 and 69, and should be avoided at all costs after the age of 70. It should be noted that, in this American publication, the hormonal treatment used is known to be much more harmful in cardiovascular terms (oral route) with an impact on metabolic balance and coagulation than the treatment used in France where hormonal treatment favours a combination of cutaneous estrogens and natural progesterone which has a favourable metabolic impact, a neutral effect on blood pressure and coagulation and therefore less cardiovascular risk.
In practice, it is very interesting to respect this notion of a window of intervention before initiating hormonal treatment for menopause. Today, this treatment is proposed in women who have disabling climacteric symptoms and who have no cardiovascular or gynecological contraindications. The cardiovascular risk must be carefully assessed before starting menopausal hormone therapy. Other factors specific to the woman must be assessed to ensure that the balance between the expected benefits and possible risks to her is appropriate. When the decision to treat is validated, treatment should be initiated in the years following the onset of menopause to limit the risk of cardiovascular accident in an older woman who has already developed atheromatous plaques in her arteries.


1. Vallée A. Menopause and risk of atherosclerosis cardiovascular disease: insights from a women's UK biobank cohort. Maturitas.2025 ;201 :108693
2 Rossouw JE, Aragaki AK, Manson JE et al. Menopausal hormone therapy and cardiovascular diseases in women with vasomotor symptoms: a secondary analysis of the Women's Health Initiative randomized clinical trials. JAMA intern Med. 2025 Sep 15 :e254510