A large Danish study of over 876,000 women provides reassurance that hormone replacement therapy is not associated with increased mortality when used appropriately.
Menopausal hormone therapy, commonly known as hormone replacement therapy (HRT), does not increase the risk of death in women, according to a major new study published by The BMJ. The research, which tracked nearly 900,000 Danish women over more than a decade, challenges longstanding concerns about the safety of hormone therapy and provides important reassurance for women managing menopausal symptoms.
The nationwide registry-based cohort study examined 876,805 women born between 1950 and 1977, following them from age 45 until July 2023. Among these women, 104,086 (approximately 12%) had redeemed a prescription for menopausal hormone therapy. Over the median follow-up period of 14.3 years, 47,594 women died (5.4% of the cohort).
At first glance, the raw data appeared concerning. Women who used menopausal hormone therapy experienced 54.9 deaths per 10,000 person-years compared to 35.5 per 10,000 person-years in women who never used it. However, this raw comparison did not account for important health factors that differ between the two groups. When researchers adjusted for age, calendar year, family history, education, income, country of birth, diabetes, high cholesterol, high blood pressure, and heart conditions, the picture changed dramatically. The adjusted results showed that hormone therapy users actually had a slightly lower mortality risk, with no meaningful difference between the groups.
The study also examined whether the length of time women used hormone therapy affected outcomes. Women who used HRT for less than one year showed no increased mortality risk. Those using it for 1-2.9 years, 3-4.9 years, 5-9.9 years, and even 10 or more years all showed no significant increase in death risk. The research found no meaningful differences in deaths from specific causes, including heart disease, stroke, and cancer—three conditions that have been subjects of concern around hormone therapy safety.
One particularly striking finding involved women who had undergone surgical removal of both ovaries (bilateral oophorectomy) between ages 45 and 54. These women who used menopausal hormone therapy experienced a 27-34% lower risk of death compared to similar women who did not use hormone therapy. This significant survival benefit suggests that hormone therapy may be particularly valuable for women facing premature menopause due to surgical intervention.
The research also found preliminary evidence that transdermal hormone therapy, delivered through skin patches or gels rather than tablets, may carry a slightly lower mortality risk, though researchers noted this finding requires confirmation in future studies.
These findings align with current clinical guidelines from major health organisations. The study supports recommendations that hormone therapy can be safely used for women who have recently entered menopause and experience moderate to severe symptoms, provided they have no medical contraindications. Common menopausal symptoms for which HRT is prescribed include hot flushes, night sweats, vaginal dryness, sleep disturbance, and mood changes that significantly impact quality of life.
It is important to note that this was an observational study, meaning researchers tracked what happened naturally rather than randomly assigning women to use or not use hormone therapy. Observational studies cannot definitively prove cause and effect, and researchers acknowledged several limitations to their work. However, the study’s strengths included its large size, use of national registry data with virtually complete follow-up records, and findings that remained consistent even when researchers tested the data in different ways. The cohort represented nearly a generation of women, providing robust long-term evidence.
The BMJ publication comes at a time when there has been renewed interest in menopausal health and HRT following earlier concerns raised by studies in the early 2000s. Those earlier findings prompted many women and clinicians to view hormone therapy with caution. This Danish research, combined with other recent high-quality evidence, suggests that for appropriately selected women, the benefits of using hormone therapy to manage troublesome menopausal symptoms may outweigh previously perceived risks.
Women considering hormone therapy should discuss their individual circumstances with their healthcare provider. Decisions about HRT should be based on symptom severity, duration, personal and family medical history, and individual risk factors. Hormone therapy is not suitable for all women—those with a personal history of certain types of breast cancer, blood clots, or uncontrolled high blood pressure may need alternative approaches to managing menopausal symptoms.
Source: @bmj_latest
Key Takeaways
- A Danish study of 876,805 women found no increased mortality risk associated with menopausal hormone therapy when appropriate health factors were considered
- Women using HRT for up to 10 or more years showed no increased risk of death from any cause
- No significant differences were found in deaths from heart disease, stroke, or cancer between hormone therapy users and non-users
- Women who underwent surgical menopause experienced a 27-34% lower mortality risk when using hormone therapy
- Findings support current clinical guidelines recommending HRT for women with moderate to severe menopausal symptoms and no contraindications
What This Means for Kent Residents
For women in Kent managing menopausal symptoms, this research provides reassurance that hormone therapy can be a safe option when prescribed appropriately. If you are experiencing troublesome menopausal symptoms affecting your quality of life, speak with your GP, who can assess your individual health profile and discuss whether HRT might be suitable for you. Women in Kent can access menopausal health services through their local GP practice, and many practices now have dedicated menopause clinics. Kent and Medway NHS Trust provides comprehensive menopause services, and your GP can refer you to a specialist if needed. You can also find evidence-based information about menopause and treatment options through NHS England’s official health information resources. Remember that every woman’s situation is unique—your healthcare provider can help you weigh the benefits and risks based on your personal circumstances.
