HRT pills vs patches: New study finds safer option for women with diabetes

HRT pills vs patches: Which are safer for heart health in women with diabetes

Hormone replacement therapy (HRT) is a common treatment for easing menopause symptoms, but its impact on heart health has been debated for years. Now, new research presented at the 2025 Annual Meeting of The European Association for the Study of Diabetes (EASD) highlights an important difference: HRT skin patches appear safer for women with type 2 diabetes than oral HRT pills.

Each year, about 25 million women worldwide experience menopause. HRT — available in pills, patches, gels, and other forms — helps manage symptoms such as hot flashes, mood changes, and sleep disturbances. However, its use has been linked to side effects including blood clots, stroke, and certain cancers.

Oral HRT may increase heart disease risk

Researchers analyzed data from more than 36,000 women with type 2 diabetes from the TriNetX global database, with an average age of 59, across the United States and Europe. Participants were followed for an average of five years to track the development of conditions such as pulmonary embolism, deep vein thrombosis (DVT), ischemic heart disease, stroke, and hormone-sensitive cancers.

The results showed:

• Transdermal HRT (patches): Women had a 25% lower risk of developing heart disease, with no increased risk of pulmonary embolism, DVT, stroke, or cancers compared with women who did not use HRT.
• Oral HRT (pills): Women had double the risk of pulmonary embolism and a 21% higher chance of heart disease compared with those using transdermal HRT.

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Lead author Dr. Matthew Anson, clinical research fellow at the University of Liverpool, said:

“Up to five years of regulator-approved doses of transdermal HRT appears safe in a large cohort of women in midlife with type 2 diabetes. Use of HRT skin patches is not associated with excess cardiovascular complications or estrogen-sensitive cancers compared with women with type 2 diabetes who did not use HRT. However, given increased risks with oral HRT, we propose that women with type 2 diabetes should not be prescribed oral estrogen therapy.”

Why this matters for women’s health

Women with type 2 diabetes face a higher baseline risk of heart disease and may not show typical heart attack symptoms. Experts say that choosing the right form of HRT can be critical for reducing cardiovascular risk.

Dr. Jennifer Cheng, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center, explained:

“This research is promising and provides evidence that women with diabetes can use transdermal HRT safely without increasing vascular risk, and may even gain cardiac benefits.”

Dr. Sherry Ross, OB/GYN and women’s health expert, added:

“The importance of this research cannot be overemphasized. Since heart disease is the number one killer of women, minimizing additional risks should be a top priority, especially in patients with existing health conditions like diabetes.”

Key takeaway

Women with type 2 diabetes considering hormone therapy should discuss transdermal HRT options with their healthcare provider, as they may lower heart disease risk compared with oral HRT pills.

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