Do I increase my risk of heart disease, by not taking HRT?

Do I increase my risk of heart disease, by not taking HRT?

by | Jan 16, 2026 | menopause, Uncategorized

January 2026

Menopause, Hormones & Heart Health

What does the Evidence Say?

Hormone therapy has become increasingly visible in conversations about menopause.  

Not only as a way to ease symptoms, but as a potential tool for long-term disease prevention.

Heart disease in particular often enters the discussion, given that women’s cardiovascular risk rises in midlife.

So it’s understandable that many women are asking: If oestrogen affects the heart, shouldn’t replacing it protect me?

A recent lecture (from Prof Susan Davis, endocrinologist and menopause researcher) exploring menopause, hormones, and cardiovascular health offers a clearer, and more nuanced look at the discussion.

The short version?

Hormone therapy can be life-changing for symptoms and quality of life. But it does not prevent heart disease. And women’s cardiometabolic risk is shaped long before menopause itself.
That might sound disappointing at first. In reality, it’s quietly empowering.

Oestrogen matters, but not as a cardiovascular cure

Oestrogen plays an important biological role in metabolism and vascular function in both women and men.

In situations of complete oestrogen deficiency (seen in rare genetic conditions or animal models) we see obesity, insulin resistance, and atherosclerosis.

But for the majority of us, menopause is not a state of total oestrogen loss.

Even after periods stop, oestrogen continues to be produced through peripheral conversion in fat, bone, and vascular tissue. This makes human menopause very different from the animal models often used in research.

Watch the video from Prof Susan Davis

Or continue reading my summary, below

 

 

Hormone therapy does not prevent heart disease

Large, high-quality trials (including the Women’s Health Initiative) consistently show that menopausal hormone therapy does not reduce coronary heart disease or heart attacks.

Importantly:
  • There was no overall cardiovascular benefit
  • There was no harm in women who were younger or closer to menopause
  • Any small improvements in blood sugar were outweighed by factors like body fat and waist circumference
Key takeaway: Oestrogen should not be prescribed to prevent cardiovascular disease. 

Starting HRT earlier than symptoms begin, doesn’t guarantee you an advantage

You may have heard of the ‘timing hypothesis’. The idea that oestrogen is heart-protective if started early enough.

The evidence doesn’t support this in a strong enough way for medical guidelines to change (a nuance often lost on social media).

Studies where oestrogen was started within a few years of menopause show:

  • No meaningful reduction in real cardiovascular events
  • At best, small changes in surrogate markers, similar to what lifestyle changes can achieve
Key takeaway: Starting hormones early does not reliably prevent heart disease.

Important shifts happen before menopause

This is one of the most important insights from Prof Susan Davis’ lecture.

Many of the changes we associate with menopause actually begin during perimenopause, when oestrogen levels can still be relatively high:

  • Weight shifting toward the middle
  • Sleep becoming more fragmented
  • Increasing insulin resistance
  • Early vascular dysfunction
These shifts often accelerate before the final menstrual period, not after.
Which means that drawing a hard line at menopause misses the real window when risk is developing.

It would be a mistake to wait for symptoms of peri menopause to develop before considering the power of small and influential lifestyle change.

Key takeaway: Women’s cardiovascular risk is shaped long before oestrogen ‘drops’.

What does this mean for hormone therapy?

None of this means hormone therapy isn’t valuable.
It absolutely is.

Menopausal hormone therapy:

  • Is the most effective treatment for hot flushes and night sweats
  • Can improve sleep, quality of life, and day-to-day functioning
  • Can be used safely for symptom relief, even in many women with cardiovascular risk
Non-oral (transdermal) oestrogen, in particular, is associated with lowered health risk and is often preferred when risk factors are present.
There is no fixed expiry date. Continuation should be individualised.

Key takeaway: hormone therapy is for symptom relief and wellbeing, not disease prevention.

The bigger picture

Women’s cardiovascular health reflects a lifetime of influences, including:
  • Menstrual history
  • Chronic stress and emotional labour
  • Sleep disruption and shift work
  • Mental health
  • Socioeconomic pressures
  • Caregiving roles
These factors often peak before menopause, and they carry forward.

Hormones matter, inside a much larger life-course story.

This perspective reflects how I approach midlife health in my work. To support women with evidence, reassurance, and practical ways to feel more resourced in their bodies and lives.

"So what do this mean for me, at midlife?"

It means we stop looking for a single fix and accept what can be done now.

Hormone therapy can support comfort and quality of life. And for many women, that matters enormously. But long-term health is also shaped by how supported, regulated, rested, and resourced a woman feels in her life.

This isn’t bad news. It’s grounding.

Because it means there is far more within your influence than a prescription alone.

Clinical principle: Hormone therapy is a symptom-management tool, not a disease-prevention strategy.

 

Hormone therapy can be a valuable tool for symptom relief, but it is only one part of a much bigger picture.

In my work with women in midlife, I support a whole-system approach that combines evidence-based information with practical, compassionate support for this stage of life.

If you would like to explore that approach further, you can contact me here: info@angiegarton.com

I currently work with women one to one, and in small groups, both online and in person. 

If you’ve not yet joined my online community – Finding Yourself In Menopause – then check out the link below.

We are available to all women, at any stage of their midlife and menopause journey.

Finding Yourself In Menopause

 

Can we really talk about menopause at work?

Can we really talk about menopause at work?

by | Oct 13, 2025 | menopause, peri-menopause

October 2025

Menopause isn’t a flaw or a weakness. It’s a human experience.

From my experience, (most) workplaces need to catch up.

Can you imagine being able to talk about your experiences of midlife and menopause, at work?

I was chatting about this with a friend on his podcast, last week.

Maybe you have a workplace right now, maybe you don’t

Either way, there’s still room for your opinion here.
(I’d love to hear it, you’re welcome to contact me)

When I’m asked to give a webinar, or help facilitate a group discussion on menopause

Although I’m talking about midlife health and how we might thrive in this era,
it’s really about:

  • Trust – Being able to say what’s on your mind without fear  
  • Respect – Your experience is true for you
  • Validity – What you say will be heard
  • Implementation – What needs to change for you to feel more at ease? (at work, or elsewhere)

Do you have anywhere you can talk like this? How do you feel about having this converstion with colleagues, not just friends?

From my experience, many are wary… for several reasons.

At the root of it all, I believe we need to revise how Western society devalues us as we age

(yes, I have a very thick brush today) 

Until this is talked about in relation to women’s health, I’ll keep banging my drum as loudly as ever!

I also want to swing the ‘menopause at work’ conversation around towards truly recognising that changing needs (health or otherwise), do not indicate flaws – personally or professionally. 

Not all of us want to discuss our personal issues at work, no.

But some of us are forced into those conversations, because symptoms don’t stop just because we’re at our desk.

It’s common to keep quiet and try to carry on.

When I ask employees about this, it’s often because they fear discrimination, aperception that they are failing at the job they know so well.

This isn’t right, at all.

Somewhere along the way of industrialisation and modern living (many many years ago), corporate conveniently forgot we are humans first, workers second.

Women first, menopausal women second.

People first, midlife people second.

Perhaps the real problem we face in managing our career alongside menopause, is that so often they are at odds with each other.

  • Menopause is all about change.
  • Workplaces thrive on predictable, repeatable outcomes.

We’re not machines though, we’re human.

And there are ways for workplace culture to respect that fact.

Where I’ve seen it done well, is when gender and individuality are genuinely respected. Not given the side eye.

It’s when ‘support’ means flexible working, and relevant policies that are visible in daily framework and work structure (not a one page leaflet next to the water cooler).

When you hear me talk about webinars and workshops about menopause, these are the kinds of discussions you can expect me to be bring.

 

If you’re curious about what I could bring to your workplace webinar or workshop for menopause month (or any other time of year), then get in touch here. Let’s chat about it.

 

If you’ve not yet joined my online community – Finding Yourself In Menopause – then check out the link below.

We are available to all women, at any stage of their midlife and menopause journey.

Finding Yourself In Menopause

Change, in epic proportions

Change, in epic proportions

by | Oct 10, 2024 | menopause, peri-menopause

October 2024

I grew up on a diet of potato waffles and ‘you can only do your best’, spoken with calm reassurance and supplemented by proper camping trips, precarious rope swings across streams, and mud pies with my sister on the back lawn.

 

I was thinking back to those times when I found some childhood photos recently. Do you remember when we took photos and actually printed them out?

I’ve got loads of them. Family albums lying almost forgotten at the back of bookcases. And shoe boxes filled with photo envelopes, the ones that came with little pockets for the negatives, in case you wanted to reprint them again.

I really enjoy looking through them. Even though it is kind of strange to observe myself, from so many years ago. When life and growing up were all so pristine new, yet I had no idea it could feel otherwise.  

I hear my clients talk about wanting to go back to who they were. Not just picking up old hobbies, or making time for previous interests, but who they were. They often talk about when life felt more simple, fewer expectations, less pressure, easier, in a way that midlife just, isn’t.

I get that. I can relate.

I do wonder though, if this sort of wistful regression, as well as (very understandably) pining for the apparent simplicity of life pre-menopause – is it also a yearning for all the versions of ourselves we have been and can never be, again?  

I’ve described this before as a kind of grief for the past, even if your todays are generally good days.

 

I do also recognise that the changes we each go through, are exactly what delivers us new versions of ourselves, to see different opportunities and make new choices.
Without it, I would be stuck, stagnant even. The same version of myself across each decade of life. I wouldn’t choose that, definitely not.

“I’m so tired” has been a common starter for ten in many of my coaching sessions with midlife women, over the last ten years. When we really dig into it though, it’s not just physical tiredness.

Tiredness and exhaustion are not just symptoms of pushing on regardless, for way too long. They’re also signs of feeling stuck, sometimes frozen in overwhelm, rumination, worry. Tired of a situation or state of mind, not just physically tired from it.

We do, truly, need change.

If midlife and menopause were delivered to us via email, I really think the subject line in your inbox would be ‘Change, in epic proportions’. And the subheading would say: ‘btw it’s not all bad’.
‘Change, in epic proportions’, is one thing for me, and another for you, and we’re both going to celebrate and commiserate on different things.

 

Opening up my photo album again, the young girl looking back at me has no idea what’s coming next.
Her dreams and aspirations have long since faded, replaced with new ideas, plot twists and pivots, over and over.
But she is still with me and that’s okay. It is because of her, that I am who I am, now.

 

The further into midlife I grow, the more I’m able to acknowledge that feeling joy and meaning and contentment is not about trying to go back to the times when I last felt those things.
I don’t need to be a past version of myself, to be truly happy, now.

 

Where I want my effort to go, is in seeing opportunity through a window of change. Some of it welcome, some of it in my control, some of it not at all. All of it happening anyway.
It’s okay to lament the past but I owe it to myself to keep making room for new decisions, new versions of myself to come forwards.
Who I am in at each turning point, that’s where my attention needs to be.

 

If you recognise that something needs to change for you, but you’re just not sure what, (or you do and that’s the problem ‘cos it feels overwhelming), then get in touch here. Let’s chat about it.

 

If you’ve not yet joined my online community – Finding Yourself In Menopause – then check out the link below.

We are available to all women, at any stage of their midlife and menopause journey.

Finding Yourself In Menopause

“Oops, I shouldn’t have said that!”

“Oops, I shouldn’t have said that!”

by | Jan 25, 2024 | menopause, peri-menopause

January 2024

He thought he’d insulted me

 

“Oops, oh sorry, I shouldn’t have said that!”, he said.

We’d only just met, but I know embarrassment when I see it.

The train we were on had just pulled into the station, so there wasn’t time to explain why he hadn’t insulted me at all.

 

If I could rewind conversation to the start, and have it over again, this is what I’d say…

When you asked me what my job is, and then made a comment to say I’m ‘at menopause’, it wasn’t an insult. You didn’t need to apologise or feel embarrassed.

I didn’t take it as an insult, at all.

What I mean is.. it shouldn’t be an insult

Many, many people would think differently, perhaps more so of your generation.

You’re retired, with a different perspective of ageing (and menopause) to me.

I don’t think it’s just a generational thing though.

The more we question our societal beliefs over the meaning of menopause, the better.

That bit is a choice.

There is even research to show that how a society views menopause as a whole, directly influences the symptoms that show up (and severity of them) for an individual within that society.

Is it an insult to say someone is menopausal?
I can see why it has been.

 

When it was synonymous with being ‘less’ of a woman, when we were expected to move aside to make way for younger women, and men, to take over, because our value has been, shockingly, in parallel to the function of our ovaries.

The way I see it, menopause is only an insult if we continue to see it as ‘all downhill from here’.

 

These days, we have more choices, more knowledge, perspectives and strategies that serve us well in how we manage this time of life, instead of it being something we’re at the mercy of.

 

No, when you implied I’m menopausal. You were kind of right.

I’m PERI menopausal. And proud of it.

Not all women get to this chapter of life.

I’m here and I’m ready for it.

 

 

If you recognise that you’re peri-menopausal (or post-menopausal), and want to increase your confidence in your approach to your health now and for the future, then get in touch here. I’d love to hear from you.

If you’ve not yet joined my online community – Finding Yourself In Menopause – then check out the link below.

We are available to all women who are seeking reassurance not just information.

Finding Yourself In Menopause

Approach with caution?

Approach with caution?

by | Sep 12, 2023 | menopause, peri-menopause

Approach With Caution?

 

Do you feel wary of bringing up the subject of menopause, around other people?

 

The last couple of years it seems like it’s ‘everywhere’.

Books, tv programmes, podcasts, social media, news articles. Many women tell me that it’s great the information is getting out there, but they’re actually quite overwhelmed by it all.

It’s not just the amount of information available to us.

 

I’ve noticed a huge change in the conversations about menopause, since I first started studying this in 2014 and then menopause coaching in 2016.

Many women tell me stories about how the increased visibility in the media has made it easier to talk about it with friends.

 

These conversations can increase awareness and curiosity, which is great, right?

Whilst it doesn’t always follow that this leads to increased acceptance, or even being able to solve all your own problems, it can certainly help with one of the most common issues that people tell me about; the feeling of loneliness that can surround this profound life transition.

 

For every woman who tells me how much it helps to talk about it, and the reassurance they get from that, there’s an equal number of people who say “I don’t know how to bring it up. I don’t want to offend anyone. I don’t want to be judged for it. I’m afraid of being put on the ‘past it’ pile”

(not my words btw)

 

I find it frustrating but unfortunately, very understandable.

There’s still a lot of stigma and misunderstanding around this part of our lives. Particularly in workplace and career settings.

 

I get it, of course. We’re not all the same.

Not everybody wants to talk about this part of their life, and that’s okay of course.

I’m certainly not saying you should or need to.

I’m saying, you have a choice.

In whether you want to or not, and in how you talk about it.

From my experience with guiding people through this thing of ‘talking about menopause’ – in group workshops, small and large group settings, where the women attending could be complete strangers, or friends, or colleagues, or just members of the same group or club – I’ve noticed a few things that I’d like to share with you now.

About what works well, and what doesn’t, for it to be useful for everyone involved. Let’s get into that now…

 

 

1.) Have you ever felt concerned of being judged harshly, or pigeon-holed, of being overlooked for promotions?

Or having to face some kind of backlash for your choices or your personal experience – even with friends?

Did you know there is workplace law to protect you from many of these pitfalls?

Whilst we don’t have a ‘menopause law’ not yet anyway, there are protected characteristics, age and gender being part of that.

 

In the UK, ACAS provide fantastic free help on this – check it out if it interests you.

The other thing is, you don’t have to share much to feel supported, particularly in a small group setting.

Many of my small-group clients have mentioned how relieved they felt to be able to say ‘oh gosh me too!’, they were just waiting for someone else to start the conversation.

This is regardless of whether it’s a conversation between colleagues or good friends.

 

 

2.) Starting the conversation could happen in a thousand different ways (it doesn’t need to be painfully awkward!)

You could mention an article you’ve read and ask if anyone else has seen it.

You could mention a particular thing you’re doing at the moment, or something you’ve recently become aware of.

I remember one lady who had a few one to one sessions with me, saying that she’d started the conversation at work by saying how much more energetic she was feeling, now she could sleep through the night and wake up feeling refreshed.

Eventually the conversation came around to energy and why sleep commonly goes awry, and the role of menopause in that.

 

‘Talking about menopause’ doesn’t necessarily involve divulging very personal information or pushing yourself towards awkward vulnerability.

You get to choose how much you share.

 

 

3.) If you’re feeling uneasy about bringing up the conversation of menopause, you’re definitely not alone in that.

Employers can be just as anxious about approaching this topic as employees, there can be pitfalls for both parties.

That’s why it can be really useful to bring in a specialist, to provide a general ‘introductory session’, to start off the conversations in a way that is inclusive for all.

This is one of the services that I provide (of course you knew I was going to say that!). It can be a one-off or a series of events either in person or online, to suit your needs.

Did you know the current statistics show one in ten women will leave a job due to menopause, resulting in potentially huge upheaval for both employer and employee.

It could be so easily avoided by providing some support, so that women feel valued and comfortable in their workplace, and are able to continue in their careers.

 

4.) Sometimes there is is a concern that by introducing the topic of menopause, some people may be offended.

The old myths and misunderstandings surrounding menopause and midlife are just that, old and outdated, but they can still be hurtful to some.

You’re right that it does need to be approached in a sensitive way.

Trying to avoid upsetting people by avoiding the conversation completely, doesn’t solve it.

Not everyone is ready to talk about it, not everyone will want to, and that’s okay.
Some people really do struggle, so it can be tricky to know where to start.

 

I’ve built up a ton of knowledge and expertise in coaching over the last ten years, so I feel qualified to say that one of the most helpful things you can do for anyone (even if you’re not sure if it is menopause they’re struggling with), is to listen to them.

You don’t need to have all the answers but you do need to know how to listen really well, and without judgement.

 

 

5.) Talking about menopause is more than a chat about HRT.

In fact in my experience as a coach I would go as far to say that talking about almost anything in your life, as a woman at midlife, is talking about menopause!

 The changes we go through, it’s not just a ‘biological event’, it’s a whole body/mind transition, our body and brain are going through a major reshuffle (or kerfuffle? you decide!) – of course it’s going to affect each of us differently.

On that note, don’t assume it’s going to be an entirely ‘negative’ conversation.

 

Sometimes laughter and jokes can hide the struggle or embarrassment, but there is also genuine joy to be found – without making us the butt of the joke (have you read my blog on the Ten Best Things About Menopause, yet?)

Some of the most common topics in my workshops and group discussions don’t always sound like they’re directly about menopause, but they are…

 

Stress, confidence, motivation, relationships; they’re all indirectly or even directly affected by what’s happening at menopause.

 

Bottom line is; there’s no rush or pressure to go in at the deep end – whether you’re with friends or at work. 

I advise that you aim for connection (the basis of support) – you don’t have to share every physical or mental ailment to do that.

6.) For many workplaces, there is often an existing framework around ‘mental health’ or wellbeing at least.

This can be the ideal stepping-stone for talking about menopause.

After all, it commonly affects not just physical health but mental health, too.
Plus, it’s no longer acceptable to write this off as a ‘woman’s problem’ to deal with on her own. The more inclusive conversations we have, the better.

 

I’ve been invited to many workplaces and mixed groups where it was recognised that everyone needed to understand more about all this, they just didn’t know how to go about it.

How do you go about it?

Well, as discussed above, pick any starting point.

It could be about mental health, or menopause, or any other aspect of health. Be aware that menopause crosses over into many areas of health – it’s not all about hot flushes and HRT.

 

In a workplace situation, let the conversation move towards some of the more practical aspects, as appropriate.

For example, what can an employer reasonably do, to help support their female staff? -well, as it turns out, there are many answers to that and it doesn’t have to include huge budgets and policy changes if you’re not ready for that yet.

There are some really simple and effective ways of increasing awareness, replacing myths with helpful advice, and improving the capacity for conversation and support overall. 

Get in touch if you want to know more.

 

As you’re likely aware, menopause can touch so many aspects of our lives.

It’s not a disease to eradicate, it’s a part of our lives that we need to be acknowledged by those around us, in a respectful way.
If you’re looking for help or advice in this area, get in touch here.

If you’ve not yet joined my online community – Finding Yourself In Menopause – then check out the link below.

We are available to all women who are seeking reassurance not just information.

Finding Yourself In Menopause