Review reassesses the safety of menopausal hormone therapy

Menopausal hormone therapy is the most effective treatment for vasomotor and other estrogen-deficiency symptoms, but safety concerns have shaped its use. This review examines evidence on systemic MHT, including the Women’s Health Initiative trial, subsequent analyses and international guideline recommendations. It discusses how adding a progestogen addressed endometrial safety concerns for women with an intact uterus, and how later analyses informed the “timing hypothesis.”

The review reports that the benefit–risk profile depends partly on age and time since menopause when treatment begins. Transdermal estradiol is associated with lower venous thromboembolism risk than oral estrogen. Micronized progesterone and dydrogesterone may have a more favorable breast safety profile than some synthetic progestins, although randomized evidence for these differences is lacking. The review describes the overall profile as favorable for healthy women starting MHT before age 60 or within 10 years of menopause.

The authors support individualized treatment decisions based on symptoms, age, time since menopause, formulation, route and individual risk factors. These conclusions synthesize existing evidence rather than report a new trial; formulation-specific safety comparisons remain uncertain, and the review calls for further comparative randomized research.