Hi @bayhorse the article that you were referring to was from 2013, not 2023, I believe. It's related to VTE (venous thromboembolism). When one uses bioidentical form of estrogen (E2, or estradiol) topically either transdermally or intravaginally, there is very little added VTE risks since estradiol bypasses liver metabolism.

There are two well designed clinical studies for estrogen's effect on cvd risks: KEEPS (2019) and ELITE (2016). ELITE (Early verses Late postmenopausal Treatment with Estradiol) is of special interest to us: it concluded that "Oral estradiol therapy was associated with less progression of subclinical atherosclerosis (measured as CIMT) than was placebo when therapy was initiated within 6 years after menopause but not when it was initiated 10 or more years after menopause. Estradiol had no significant effect on cardiac CT measures of atherosclerosis in either postmenopause stratum. (Funded by the National Institute on Aging, National Institutes of Health; ELITE ClinicalTrials.gov number, NCT00114517.)". This is why many doctors are reluctant prescribing hrt if a woman is postmenopausal for more than 10 years.

During my exploration on the feasibility of hrt therapy (I was just a little over 10 yr past menopause at the time), one statement stood out - one can be 55 years old having a cardiovascular health of a 65 year-old, or, vice versa. So the key is to find a cardiologist who is familiar with this topic and to get an individualized cvd risk assessment.

You might already read the thread "HRT safety" where many members discussed the topic:
https://connect.mayoclinic.org/discussion/hrt-safety/

Here's one from October 2024:
Hormone Replacement Therapy
https://www.ncbi.nlm.nih.gov/books/NBK493191/
Gina Harper-Harrison; Karen Carlson; Meaghan M. Shanahan.
Author Information and Affiliations

Last Update: October 6, 2024.

See: Transdermal formulations

Conversely, transdermal estrogen bypasses the hepatic metabolism that produces activated protein-C resistance, negating the risk of blood clotting seen with oral formulations.[11] Transdermal estradiol offers several benefits, including avoiding the digestive system and liver metabolism, resulting in no changes to thyroid-binding globulin or hepatic coagulation proteins at standard doses. Transdermal delivery has minimal impact on the risk of VTE and is convenient, typically requiring application once or twice a week. This makes transdermal estrogen a better choice than oral estrogen for most women, especially patients who smoke cigarettes or have migraines. Additionally, transdermal estrogen has a neutral effect on blood lipids. However, topical forms may cause skin irritation or, rarely, allergic reactions, though this is less common with gels. Some women may experience poor absorption or forget to change the patch regularly.[8]