How does postmenopausal hormone treatment help prevent heart disease?

Based on observational studies, for decades, estrogen was thought to lower the risk of heart disease. The studies showed that women who took estrogen developed heart disease less often than women who did not take estrogen. However, the women who took estrogen had other healthy habits, such as exercising more, eating a healthier diet, and being leaner, so it was not clear if the lower rate of heart disease was due to estrogen or the other habits.

The Women's Health Initiative, funded by the National Institutes of Health, tried to answer that question, among others. It conducted two randomized trials to find out if postmenopausal estrogen did prevent heart disease. In one study, women with a uterus were assigned either estrogen with progestin or a placebo.

The progestin was given to prevent cancer of the uterus, which estrogen can induce. Estrogen with progestin increased heart attack, breast cancer, stroke, dementia, and blood clots in the legs. Fractures and colon cancer were reduced by estrogen with progestin, but these benefits were not enough to offset the risk of the hormones.

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