How does estrogen affect a woman's risk of heart disease?

Kelly Anne Spratt, DO
Cardiology (Cardiovascular Disease)

Estrogen, a naturally occurring hormone, provides protection to a woman’s cardiovascular system during her reproductive years, from approximately age 12 to 50. However, estrogen's protective effects seem to wane as women age. It may even actually increase the risk of heart attack or stroke if given as a hormone replacement therapy during menopause.

Marina Johnson
Endocrinology Diabetes & Metabolism

Estrogen has many protective actions on the heart. It dilates arteries and decreases inflammation that leads to plaque formation. It raises the good cholesterol, HDL and decreases the bad cholesterol, LDL. It reduces blood pressure, decreases excessive clotting of platelets and reduces insulin resistance.

A meta-analysis combines results from multiple independent studies of the same problem to increase the statistical accuracy of the analysis. A meta-analysis of 23 randomized, controlled studies (RCTs) comparing hormone replacement therapy (HRT) to placebo, showed a 32% reduction in heart disease in women starting HRT younger than 60 or within 10 years of menopause. A meta-analysis of 30 RCTs comparing HRT to placebo showed a 39% reduction in the risk of dying in women starting HRT younger than 60 or within 10 years of menopause.

Read more in my guidebook for women, “Outliving Your Ovaries:  An Endocrinologists Reviews and Risks and Rewards of Treating Menopause with Hormone Replacement.”


Prior to menopause, estrogen is thought to provide some protection to women against heart disease. (Premenopausal women who have diabetes or who smoke are not adequately protected by estrogen because diabetes and smoking are major risk factors for heart disease.)

Scientists are still learning about the actions of estrogen on the body. In terms of the cardiovascular system, estrogen works to keep a woman's arteries free from atherosclerotic plaque (the buildup of fatty substances, cholesterol, cellular waste and other material) partly by improving the ratio of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. Estrogen increases the amount of HDL cholesterol, which helps clear LDL cholesterol from the bloodstream, the type of cholesterol that contributes to plaque buildup in the arteries. LDL cholesterol is a major cause of coronary heart disease (CHD), according to the National Cholesterol Education Program of the National Heart, Lung, and Blood Institute.

Yet, research in women who started on hormone therapy an average of 10 years after menopause showed a slight increase in risk of heart attack and stroke. However, it is uncertain if taking supplemental estrogen early on after menopause can reduce your risk of cardiovascular events, and ongoing studies continue to evaluate the effect of hormone therapy on CHD.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.