According to an international study older women should not take Hormone Replacement Therapy (HRT).
The researchers say for women in their 60s and 70s, HRT has more risks than benefits.
However they say HRT is a safe short term treatment for younger women going through early menopause to relieve symptoms and improve quality of life and also boosts heart health.
The WISDOM trial looked at 5,692 healthy women in the UK, Australia and New Zealand with an average age of 63 years and 15 years beyond the menopause.
The trial stalled for a time in 2002 after a major U.S. study, the Women's Health Initiative (WHI), was stopped because it found women taking HRT had more heart attacks and strokes than non-users.
But scientists now believe that these risks may only apply to older women who do not normally use HRT.
The women in the WISDOM trial were were given combined hormone therapy, containing oestrogen and progestogen hormones, oestrogen-only therapy or a dummy pill each day and monitored for an average of 12 months.
During this period the researchers found there was a 'significant increase' in heart attacks, sudden coronary deaths or angina, and blood clots in the combined therapy group compared with non-users.
They also found there was no difference in rates of stroke, breast or other cancers, fractures, or overall deaths.
The researchers say the results do not necessarily apply to younger women taking HRT for relief of symptoms such as hot flushes and night sweats; a view supported by recent studies which suggest there may be heart benefits for women taking HRT around the time of the menopause - rather than as a 'treatment' in later life.
Numerous health scares in the past six years have resulted in millions of women stopping HRT but experts maintain for women suffering menopausal symptoms HRT does not pose a risk to their heart, they are no more likely to suffer strokes, and do not have an additional risk of breast cancer from short-term use and HRT will also give them protection from osteoporosis.
The results support the early findings of the WHI and other trials that combined oestrogen and progestogen therapy should not be initiated to prevent cardiovascular disease in older postmenopausal women.
The authors say HRT should not be prescribed to older women who are many years past menopause to help prevent chronic conditions such as heart disease but support the view that HRT is a safe short term treatment for younger women in early menopause to relieve symptoms and improve quality of life.
The study was funded by the UK's Medical Research Council and is published by the British Medical Journal.