Menopause Hormone Therapy: Large Study Finds No Increased Mortality Risk

A large Danish study has found that menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), is not associated with an increased risk of death. The findings, published in February 2026 in The BMJ, offer reassurance and support current guidelines recommending MHT for women experiencing moderate to severe menopausal symptoms who have no contraindications.

MHT is used to alleviate common menopausal symptoms such as hot flashes, sleep disturbances, mood swings, and depression. However, its use has declined over the past two decades due to safety concerns, and robust real-world evidence regarding its impact on mortality has been lacking. This study aimed to address that gap.

Researchers analyzed data from nationwide Danish registers, tracking women born between 1950 and 1977 who were alive at age 45. The study excluded women with pre-existing conditions that could influence mortality, including a history of blood clots, liver disease, breast, uterine, or ovarian cancer, prior MHT use, or those who had undergone bilateral oophorectomy (surgical removal of both ovaries). Follow-up began on each woman’s 45th birthday and continued until July 31, 2023, for a median of just over 14 years.

The analysis accounted for a range of potentially influential factors, including age, parity (number of children), education, income, country of birth, and underlying health conditions such as diabetes, hypertension, and heart disease. Of the 876,805 women included in the main analysis, 104,086 (11.9%) redeemed a prescription for MHT, and 47,594 (5.4%) died during the follow-up period. The median duration of MHT use was 1.7 years, with most women (41,433, or 4.7%) using it for less than a year, and a smaller proportion (7,337) using it for 10 years or more.

Initially, the risk of death from any cause appeared higher in women who used or were currently using MHT (54.9 deaths per 10,000 person-years) compared to those who never used it (35.5 deaths per 10,000 person-years). However, after adjusting for relevant factors, this difference was no longer statistically significant.

Further analysis based on the duration of MHT use also revealed no increased risk of death, even among women who used the therapy for 10 years or longer. The study also found no clear differences in mortality rates from specific causes, such as cardiovascular disease, stroke, or cancer, between women who used MHT and those who did not.

Interestingly, the study identified a potential benefit for women aged 45 to 54 who underwent bilateral oophorectomy for non-cancerous conditions. These women experienced a significant survival benefit when using MHT, with a 27–34% reduction in the risk of death compared to similar women who did not use the therapy. This finding suggests a potential role for MHT in mitigating the health consequences of surgical menopause.

The researchers also noted a possible trend towards a slightly lower risk of death among women using transdermal MHT (delivered via patches or gels) compared to those not receiving treatment, but emphasized that this finding requires further investigation.

It’s important to note that this study is observational in nature, meaning it cannot definitively prove a cause-and-effect relationship. The authors acknowledge certain limitations, but highlight the study’s large sample size and comprehensive data as strengths. They also point out that the results remained consistent even after conducting additional analyses to test different factors and statistical assumptions.

The researchers conclude that MHT was not associated with increased mortality in this large Danish cohort. They suggest that the observed survival benefit among women who underwent bilateral oophorectomy for non-cancerous reasons warrants further consideration of MHT in this specific context. These findings align with existing guidelines that recommend MHT for women who are newly menopausal and experiencing moderate to severe symptoms, provided Notice no contraindications.

This research contributes to a growing body of evidence reassessing the safety of MHT, potentially paving the way for more informed discussions between women and their healthcare providers about the risks and benefits of hormone therapy.