What the latest research says about HRT benefits and risks: A refresher for cardios, oncos, and neuros
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Estrogen is critical in maintaining the caliber and health of blood vessels throughout the body, but especially the blood vessels that provide the heart muscle with vital circulation.
—Cathleen Brown, DO
On November 10, 2025, the Food and Drug Administration (FDA) announced that black box warnings will no longer be required on hormone replacement therapy (HRT) drugs. []
Behind the agency’s decision is over 20 years of research detailing significant health benefits linked to HRT. “There are now recognized to be profound long-term health benefits that few people, even physicians, know about,” FDA Commissioner Marty Makary, MD, MPH, said during a press conference.
Though older research suggested that HRT increased the risk of breast cancer and heart disease, newer research has overwhelmingly shown that HRT can dramatically lower the risk of heart problems when given to younger women around the time they start menopause. [] One report found that HRT is linked to a 25% to 50% reduction in fatal cardiovascular events.
Cardiology
“Estrogen is critical in maintaining the caliber and health of blood vessels throughout the body, but especially the blood vessels that provide the heart muscle with vital circulation,” Cathleen Brown, DO, a board-certified OB/GYN and medical director of telehealth company Winona, tells MDLinx.
In addition, she says, estrogen helps prevent the formation of atherosclerotic plaques in blood vessels in younger women.
By treating menopause symptoms, including hot flashes and night sweats, women are better able to maintain healthy habits, including regular exercise, a healthy diet, and a good sleep routine—all of which have been shown to improve heart health—says Katie Rowan, MD, an internal medicine physician and Menopause Society–certified practitioner.
“In that way, treating symptoms with menopausal hormone therapy may have an indirect benefit for heart health,” she says.
It’s worth noting that the FDA does not recommend taking HRT to prevent heart attack or stroke. []
Neurology
As for the neurological effects? Scientists are still teasing those out. Some reports have linked HRT to a lower risk of dementia, but those studies were observational. []Large, randomized clinical trials are needed to better understand the association between HRT and brain health, according to Dr. Rowan.
As such, she says, “use of menopausal hormone therapy (MHT) solely for improving brain health is not supported by data and is not an indication for MHT.”
Oncology
Regarding cancer, doctors now widely agree that the 2002 Women’s Health Initiative (WHI) study misinterpreted and overstated the risks. []
Upon reexamining those findings, scientists determined that the heightened risk of breast cancer was influenced by the fact that the WHI recruited older women—with an average age of 63—who, over a decade older than the average age of a woman experiencing menopause, have different health statuses and risk profiles. []
In addition, the drug formulation used in the WHI study is no longer commonly used. [] Newer formulations and delivery methods, such as the transdermal route, do not appear to increase a woman’s risk of breast cancer. []
In fact, growing evidence suggests that HRT may lower the risk of certain cancers, such as colorectal cancer, when administered at a younger age. []
In addition, vaginal estrogen, which does not have a systemic effect but is instead applied to the vagina to treat itchiness and discomfort, has been linked to lower mortality in breast cancer survivors, Dr. Rowan says. Why? “Likely because it helps prevent urinary tract infections and associated complications,” she says.
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