If hot flashes or night sweats are disrupting your life, you may have wondered whether hormone therapy is right for you.
A new analysis from the Study of Women’s Health Across the Nation (SWAN), published in JAMA Internal Medicine on September 8, 2026, offers encouraging information.
Among women with vasomotor symptoms: such as hot flashes and night sweats: those who began hormone therapy during perimenopause or early postmenopause had a 22% lower risk of cardiovascular disease over approximately 20 years compared with women who did not use hormone therapy.
That is meaningful.
It is also not a reason to start hormone therapy solely to prevent heart disease.
Here is what women over 40 need to know.
Start with the key finding
The SWAN researchers studied women who experienced vasomotor symptoms and did not have cardiovascular disease at the beginning of the analysis.
Women who initiated menopausal hormone therapy during perimenopause or early postmenopause showed a lower rate of cardiovascular events during long-term follow-up.
The study included events such as:
- Heart attack
- Stroke
- Heart failure
- Other forms of cardiovascular disease
The overall association was a 22% lower cardiovascular risk among hormone therapy users.
The finding supports an important idea: when hormone therapy begins may matter.
It does not mean that hormone therapy prevents heart disease for every woman. It does suggest that starting treatment near the menopause transition may have a different cardiovascular profile than starting much later.
Timing matters most
The strongest results appeared among women who began hormone therapy within 10 years of menopause onset.
This period may include:
- Perimenopause, when menstrual cycles and hormone levels begin changing
- Early postmenopause, generally the first years after the final menstrual period
- The early 50s for many women, although every person’s timeline is different
Women who started therapy more than 10 years after menopause onset did not show the same clear benefit in this analysis.
This timing pattern is sometimes called the “timing hypothesis.” It suggests that the body’s response to hormone therapy may differ depending on age, time since menopause, blood vessel health, and existing cardiovascular risk.
Think of timing as one part of the conversation: not the entire decision.
Your blood pressure, cholesterol, blood sugar, smoking history, family history, migraine history, medications, and personal medical history also matter.
Black women showed the strongest estimated benefit
The study reported the most pronounced association among Black women.
In this group, beginning hormone therapy during perimenopause or early postmenopause was associated with an estimated 49% lower risk of cardiovascular disease compared with non-use.
This finding deserves attention because Black women often experience:
- Earlier onset of menopause symptoms
- More frequent hot flashes
- More severe or longer-lasting vasomotor symptoms
- Higher rates of several cardiovascular risk factors
At the same time, the result requires thoughtful interpretation.
Subgroup findings can be influenced by sample size, underlying health differences, access to care, treatment patterns, and other factors researchers cannot fully measure. The study does not mean hormone therapy is automatically safer or more beneficial for every Black woman.
It does mean that Black women should be included in informed, respectful conversations about symptom treatment and cardiovascular health.
Your symptoms deserve to be taken seriously. Your racial and personal health history deserve careful consideration. You do not need to accept a one-size-fits-all answer.
The important caveat: this was not a prevention trial
The SWAN analysis was observational.
That means researchers examined patterns in real-world health data. They did not randomly assign women to hormone therapy or placebo.
As a result, the study can show an association. It cannot prove that hormone therapy directly caused the lower cardiovascular risk.
Women who chose hormone therapy may have differed from non-users in other ways. They may have had different access to healthcare, health behaviors, income, treatment preferences, or baseline risks.
The authors do not recommend prescribing hormone therapy specifically for cardiovascular disease prevention.
That distinction matters:
Hormone therapy may help relieve bothersome menopause symptoms, with a possible heart-health benefit for some women who start treatment near menopause. It is not a general prescription for preventing heart disease.
Hormone therapy also has potential risks. Those risks depend on factors such as:
- Your age and time since menopause
- Whether you have a uterus
- The type and dose of hormone therapy
- Whether treatment is oral, transdermal, or another formulation
- Your personal and family history
- Your risk of blood clots, stroke, breast cancer, or other conditions
Make the decision with a qualified clinician who understands your complete health picture.
Ask better questions at your next appointment
Prepare before your visit. Write down your symptoms, when they began, how they affect sleep and daily life, and what you have already tried.
Then ask:
- Are my symptoms consistent with perimenopause or menopause?
- What are my personal cardiovascular risk factors?
- Would hormone therapy be appropriate for my symptoms and health history?
- How does my time since menopause affect the decision?
- Would a patch, gel, pill, or another option be safest for me?
- Do I need progesterone along with estrogen?
- What benefits should I expect, and how soon might I notice them?
- What risks should I watch for?
- How long should we try treatment before reassessing?
- What nonhormonal options could also help?
Use this hormone therapy appointment checklist to help organize your conversation.
Support your heart during the menopause transition
Whether or not hormone therapy is right for you, take practical steps that support cardiovascular health.
Start with the basics:
- Check your blood pressure regularly.
- Know your cholesterol and blood sugar numbers.
- Move your body in ways you can sustain.
- Prioritize protein, fiber, fruits, vegetables, and healthy fats.
- Protect your sleep as much as possible.
- Avoid smoking and seek support if quitting feels difficult.
- Manage stress with realistic, repeatable practices.
- Schedule preventive visits instead of waiting for symptoms to become urgent.
You do not need to change everything this week.
Choose one valuable action. Schedule a screening. Take a walk. Prepare your appointment questions. Set a bedtime that gives your body more recovery time.
Small steps become powerful when you repeat them.
Take control of the next conversation
The menopause transition is not a health failure. It is a new stage that deserves informed support.
Use the SWAN findings as a reason to ask better questions: not as a reason to feel pressured into treatment.
You can ask for a complete risk assessment. You can discuss hormone and nonhormone options. You can request a second opinion. You can change course as your health and priorities evolve.
Most importantly, you can participate actively in the decision.
Medical disclaimer
This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. The information references clinical research, including an observational analysis from the SWAN cohort, and should not be used to make personal healthcare decisions without speaking with a qualified healthcare professional. Hormone therapy may not be appropriate for everyone. Discuss your symptoms, risks, benefits, alternatives, and treatment goals with your own clinician.
Ready for your next powerful step?
Join the Midlife Reset waitlist for practical, evidence-informed support designed to help women over 35 feel vibrant, informed, and in control of their health journey.