Article 2: Why Starting BHRT Too Late May Increase Heart RisksThe timing of hormone therapy matters.

The timing of hormone therapy matters. Starting BHRT long after menopause — usually more than a decade past the transition — can change the way the body responds. When estrogen has been absent for many years, arteries may stiffen and cholesterol may build up in vessel walls. At that stage, adding estrogen may not protect the heart as well as it does when started earlier, and in some cases could worsen cardiovascular risk.

This is known as the “timing hypothesis.” Studies show that women who begin BHRT early, in their 40s or 50s, often have healthier arteries and reduced risk of heart disease compared with those who delay. By contrast, waiting until the 60s or 70s to start treatment may not provide the same protective benefits and could raise risks of blood clots or stroke.

For women considering BHRT, the message is clear: earlier use, when symptoms first appear, is often safer and more effective. Discussing treatment with a qualified provider during perimenopause or early menopause helps maximize benefits while reducing risks.

References

1. Manson, J. E., et al. (2013). Menopausal hormone therapy and long-term mortality. JAMA, 310(13), 1353–1368.

2. Rossouw, J. E., et al. (2002). Risks and benefits of estrogen plus progestin. JAMA, 288(3), 321–333.

3. Hodis, H. N., et al. (2016). Vascular effects of early vs. late estradiol treatment. New England Journal of Medicine, 374(13), 1221–1231.