- Hormone replacement therapy (HRT) can help improve symptoms associated with menopause but it has sometimes also been associated with certain health risks.
- The latest research, however, suggests that the existing evidence does not support the notion that HRT could cause harm during and after menopause.
- In fact, some recent studies have linked it to better weight management and improved bone health.
These are due to fluctuating or dropping hormone levels, particularly estrogen. The main way of managing menopause symptoms is through hormone replacement therapy (HRT), also known as menopause hormone therapy.
Historically, doctors had been concerned that hormone therapy could sometimes result in serious side effects but the narrative is now shifting, as mounting evidence increasingly suggests not only that HRT is safe but that it may be associated with more benefits than previously thought.
Here is a round-up of the most recent research and what it has found.
The review analyzed data from 10 studies, nine of which were observational, and one a randomized controlled trial, which totalled 1 ,016, 055 participants between them.
Its findings appear to support the decision taken by the Food and Drug Administration (FDA) in November 2025 to remove black box warnings for HRT products in a move to clarify the safety of these forms of therapy.
Commenting on the black box warning removal, Prudence Hall, MD, an OB/GYN in private practice in Santa Monica, CA, told Medical News Today that hormone replacement therapies available at present have greatly improved in quality, compared to the products that were available historically.
“Decades ago, beginning around 1945, a product called Premarin, derived from the urine of pregnant horses, was commonly prescribed along with synthetic progesterone,” Hall explained.
“Today, we have far better, more natural options. The form of HRT I use [in clinical practice] is bioidentical, meaning these hormones are molecularly identical to those naturally produced by a woman’s body,” she noted.
More specifically, postmenopausal women taking HRT plus tirzepatide achieved 35% more weight loss than those taking tirzepatide without HRT.
“The greater weight loss we observed suggests that menopausal hormone therapy may be an important modifier of response to tirzepatide, pointing toward a more personalized approach, where menopausal status and menopausal hormone therapy use is considered when counseling midlife women and designing treatment plans.”
First author Regina Castaneda, MD, a postdoctoral research fellow at Mayo Clinic, cautioned that the study was observational and could not, thus, prove a causal relationship.
Nevertheless, Castaneda said that the study “underscores the need for prospective trials to determine whether and how menopausal hormone therapy modifies response to obesity pharmacotherapy.”
Another concern during and after menopause is the increased risk of osteoporosis due to lower estrogen production.
The research was conducted with the participation of 137,484 individuals under the age of 60 who had gone through menopause.
It found that those who did not initiate HRT within a year from the start of their menopause symptoms had a 18% higher risk of osteoporosis at the 5-year follow-up than those who started hormone therapy early.
“As our population ages, age-related conditions like bone loss have become common, and the risk of falling and fracturing bones increases exponentially. From an orthopedic standpoint, this often leads to hospitalization, surgery and morbidity.”
“Anything we can do to mitigate the risk of conditions like osteoporosis and fractures for postmenopausal women is a positive step,” said James Barsi, MD, FAAOS, clinical associate professor of Orthopaedic Surgery at Stony Brook University, NY, and one of the authors of this study, in a press release.
“The data from this study is particularly meaningful because of the large number and uniformity of participants, and we hope it leads to more doctors having conversations with eligible patients about HRT as an option,” Barsi concluded.
