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As women move through menopause, hormonal changes—particularly in estrogen and progesterone—can influence many aspects of health, including cardiovascular function. One area of growing research interest is the possible relationship between bioidentical hormone replacement therapy (BHRT) and heart health.

While some studies have explored potential associations, BHRT is not currently approved as a treatment for the prevention of cardiovascular disease. It may, however, be part of a broader symptom management plan when prescribed by a qualified healthcare provider.

Hormones and the Cardiovascular System

Estrogen plays a complex role in vascular health, lipid metabolism, and inflammatory response. Before menopause, women typically have lower rates of certain heart conditions compared to men. After menopause, cardiovascular risk increases—though this is influenced by many factors, not just hormones.

The decline in estrogen during menopause may contribute to shifts in cholesterol, blood pressure, and other risk markers, but cardiovascular disease (CVD) is multifactorial. Lifestyle, genetics, age, and coexisting conditions all play a role.

What Is BHRT?

BHRT refers to hormone therapy using estrogen and progesterone that are structurally identical to those produced naturally in the human body. In Canada, only regulated hormone therapies approved by Health Canada should be used for symptom management during menopause. These products are manufactured to specific standards for quality, safety, and efficacy.

What Does the Evidence Say About BHRT and Heart Health?

Some observational and randomized studies have explored how certain forms of hormone therapy—such as transdermal estradiol or micronized progesterone—may influence cardiovascular markers. In some cases, initiating therapy early in menopause has been associated with fewer adverse cardiovascular outcomes in selected populations.

However, the evidence remains mixed, and more large-scale research is needed to clarify:

• Whether hormone therapy can reduce cardiovascular risk
• Which patients might benefit most
• The role of dosage, formulation, and route of administration

BHRT is not currently indicated as a preventive treatment for heart disease, and decisions about hormone therapy should be made on an individual basis.

Is BHRT Right for You?

Hormone therapy may be appropriate for managing certain menopausal symptoms, particularly if started close to the time of menopause. It is not suitable for everyone. Factors like a personal or family history of blood clots, stroke, or certain cancers may influence whether it’s recommended.

Treatment decisions should be based on:

• A full review of your medical history
• Your current symptoms
• An assessment by a licensed healthcare provider

Any use of BHRT should include regular follow-up and monitoring to ensure the treatment remains appropriate over time.

The Bottom Line

The relationship between hormones and heart health is an active area of research, and BHRT may be one option considered as part of a broader care plan for menopausal symptoms. However, it is not a one-size-fits-all solution—and it is not approved for the prevention of heart disease.

If you’re navigating menopause and exploring your options, speak to a licensed healthcare provider about whether hormone therapy might be suitable for your individual health needs.