Main conclusion
An update of 24 randomized trials involving 45,660 women confirms that the long-term balance of menopausal hormone therapy depends on regimen and outcome. It should not be initiated solely for general prevention of chronic disease.
What was studied
Combined therapy probably reduced fractures, but increased breast-cancer risk and probably thromboembolic events. Estrogen alone also reduced fractures, while increasing stroke and gallbladder disease. The review did not assess symptom relief.
Key limitations
Almost 70% of the evidence came from HERS and WHI. Most women were older than 60, and oral conjugated equine estrogen and medroxyprogesterone dominated. Only one study focused on perimenopause. Direct transport to every younger symptomatic woman using transdermal estradiol and micronized progesterone is not justified.
What this means in practice
Symptom treatment must be separated from chronic-disease prevention. Decisions should incorporate age, time since menopause, uterine status, route, progestogen, and individual risk.
Source
Cochrane Database of Systematic Reviews, 2026. DOI: https://doi.org/10.1002/14651858.CD004143.pub7 PubMed: https://pubmed.ncbi.nlm.nih.gov/42695385/
Educational material; it does not replace individual medical advice.