Starting estrogen in early menopause may translate into a slightly lower risk of heart disease, but the magnitude of risk reduction seen in observational studies is unlikely to hold up in randomized trials.

“my thought was that women in early menopause who are transitioning from having their natural pre-menopausal estrogen exposure which many studies suggested was protective a cardio protective favorable in terms of risk factor status in terms of dilating the blood vessels to the heart and increasing blood flow to the heart there were many studies already suggesting that a woman's own natural estrogen during pre-menopausal years was one of the reasons why women started to have heart disease later 10 years or more later than men my thoughts were that it is likely that starting estrogen in early menopause would translate into at least a slightly lower risk of heart disease but I was skeptical from the very start that the magnitude of risk reductions seen in the observational studies you know the 40 50 percent lower risk of heart disease would stand up to a randomized clinical trial assessment of this question”