Red Hot Mamas In Charge of Change.
By: Red Hot Mamas
Published: December 3, 2025
The Menopause Society has prepared these FAQs in response to some commonly asked questions about hormone therapy. The Society is dedicated to providing evidence-based information to our members and the public to ensure that women are receiving the best care.
Question: Should hormone therapy be used to prevent heart disease?
No. Hormone therapy is not recommended for primary or secondary prevention of cardiovascular disease.
The effects of hormone therapy on coronary heart disease (CHD) vary depending on when it is initiated in relation to time since menopause and age. In younger women who are within 10 years of menopause onset, there is a favorable effect on CHD and all-cause mortality that needs to be considered against potential rare increases in risks of breast cancer, venous thromboembolism, and stroke. Women who initiate hormone therapy 20 to 30 years after the onset of menopause are at higher risk of coronary heart disease, venous thromboembolism, and stroke than women initiating hormone therapy early in menopause.
Reference: The 2022 Hormone Therapy Position Statement of The Menopause Society
Question: Should hormone therapy be used to prevent dementia?
No. Hormone therapy is not recommended for prevention or treatment of cognitive decline or dementia. At the present time, we do not have evidence that the use of hormone therapy in women undergoing menopause at the usual age prevents dementia.
It may have cognitive benefits when started in women after hysterectomy and oophorectomy before menopause onset. The risk of dementia was increased in women aged older than 65 years who initiated conjugated equine estrogens plus medroxyprogesterone acetate in the Women’s Health Initiative Memory Study.
Reference: The 2022 Hormone Therapy Position Statement of The Menopause Society
Question: Does hormone therapy prevent bone loss and protect against fracture risk?
Yes. Hormone therapy is US-government approved for prevention of bone loss and can be used for this purpose in women who do not have contraindications and who are appropriate candidates.
Hormone therapy prevents bone loss and reduces fracture risk in healthy, postmenopausal women, with dose-related effects on bone density. Hormone therapy is not US-government approved for treatment of osteoporosis, and other management strategies should be considered in women with osteoporosis.
Stopping hormone therapy results in initial rapid bone loss and potentially in transiently increased fracture risk with longer-term protection.
Unless contraindicated, women with premature menopause should use hormone therapy to prevent bone loss and reduce fracture risk until the average age of menopause when treatment may be reassessed.
References: The 2022 Hormone Therapy Position Statement of The Menopause Society
Discontinuation of Menopausal Hormone Therapy and Risk of Fracture
Question: I am in my 60s. Is it too late to start hormone therapy?
It depends. There is nothing magic about the age of 60 with regard to starting hormone therapy. More important are time since menopause, with risks being lower in women who are within 10 years of menopause onset, existing contraindications, risk factors for cardiovascular disease and breast cancer, and reasons for initiating hormone therapy (eg, bone protection, hot flash management). Hormone therapy should not be used for prevention of heart disease, dementia, or aging in general. Shared decision-making between women and their clinicians is essential, because these discussions are often nuanced.
References: The 2022 Hormone Therapy Position Statement of The Menopause Society
The Menopause Society Statement on Hormone Therapy Misinformation
Question: Should hormone therapy be used for weight loss?
No. Hormone therapy has favorable effects on body composition but typically does not result in weight loss.
There is a link between adiposity and menopause symptoms. Adiposity, and particularly central adiposity, is associated with increased vasomotor symptom severity. Although weight loss via lifestyle intervention has been associated with decreased frequency and severity of vasomotor symptoms, the effect of weight loss medications on vasomotor symptoms is limited.
There is preliminary evidence that hormone therapy use may augment response to weight loss medications, but additional study is needed before this can be recommended as standard practice in clinical care.
References: The 2022 Hormone Therapy Position Statement of The Menopause Society
Practice Pearl: Pharmacologic Options for the Treatment of Overweight and Obesity
Question: Are there benefits to starting hormone therapy before menopause onset?
No. There is no data to support the use in perimenopause to “prevent” menopause or chronic disease. Although hormone therapy can be used for symptom management in perimenopause, it is not a high-enough dose to prevent pregnancy or to control heavy menstrual bleeding. It can be used in combination with a progestin-containing intrauterine device that does provide contraception. Alternatively, a low-dose hormone contraceptive pill/patch/ring may also be an option for contraception, management of heavy menstrual bleeding, and symptom management in perimenopausal women.
References: Practice Pearl: Contraception in Perimenopause
Question: Are there different indications for the use of systemic and vaginal estrogen?
Yes. Low-dose vaginal estrogen is used for management of genitourinary symptoms, such as vulvovaginal dryness, itching, irritation, and pain with sexual activity, along with urinary symptoms of urgency and frequency. There are also data suggesting that it reduces the risk of urinary tract infections in postmenopausal women.
Systemic estrogen is US-government approved for management of vasomotor symptoms and prevention of bone loss and may have some beneficial effects for sleep and mood.
Systemic estrogen may also be effective for management of genitourinary symptoms, but the use of low-dose vaginal estrogen is preferred in women who are only experiencing these symptoms. For women on systemic hormone therapy who continue to experience genitourinary symptoms, the addition of local, low-dose estrogen may be needed.
References:The 2022 Hormone Therapy Position Statement of The Menopause Society
Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline
