Menopause Hormone Therapy: Panacea, Poison, or something in between?

A new viewpoint in JAMA Internal Medicine explores the changing perceptions of menopausal hormone therapy (MHT), including shifts in perception, popularity and use.

While promoted as a panacea for ageing in the late 20th century to stave off the health effects of ageing, women discontinued MHT in record numbers in the early 2000’s when the Women's Health Initiative trials revealed increased risks of cardiovascular events, stroke, thromboembolism, and dementia in older women, despite benefits for fractures, diabetes, and colon cancer.

Recent data indicate MHT carries lower cardiovascular risk for younger postmenopausal women with vasomotor symptoms, though it is not recommended for primary chronic disease prevention.

The authors advocate viewing menopause is a complex, multisystem transition that requires individualised, multidisciplinary care, with MHT as one option alongside underutilised nonhormonal therapies and behavioural strategies. They urge expanded clinician training, evidence-based information dissemination, and research investment to address care gaps for women, who are spending nearly half their lives in peri- or postmenopause.