Does hormone therapy help women age more healthily?

Around the time of menopause, oestrogen production declines, and that has measurable consequences for the body. Abdominal fat increases, the lipid profile worsens, blood pressure rises, and cells become less responsive to insulin. These changes cannot be attributed purely to ordinary ageing: menopause itself appears to be an independent risk factor for cardiovascular disease, and the earlier it begins, the greater that risk.

Hormone therapy (oestrogen, sometimes combined with progestogen) relieves menopausal symptoms well. Hot flushes, night sweats, vaginal dryness, sexual problems and mood complaints decrease noticeably. Bone loss is also slowed. The evidence for these applications is the strongest and most consistent.

In the area of weight and metabolism, the indications are positive but less certain. Hormone therapy appears to slow the menopause-related increase in abdominal fat and total body fat, to improve insulin sensitivity, and to reduce the risk of type 2 diabetes. The evidence here is moderate and partly associative. Which women benefit most from hormone therapy for this purpose has not yet been thoroughly investigated.

The cardiovascular risk picture is the most complicated part. Some studies find a protective effect, while others find an increased risk. The timing of when therapy is started (shortly after menopause versus years later), the type of hormone, and the route of administration all turn out to be decisive. No general statement can be made: the effect is highly individual.

Regarding the brain, oestrogen has neuroprotective effects, and women after menopause appear to face a higher risk of cognitive decline and neurodegenerative disease. But whether hormone therapy actually reduces that risk has not been sufficiently studied. Furthermore, the hormones FSH and LH, which rise at menopause and may contribute to brain problems, are not affected by standard hormone therapy. Finally, hormone therapy has absolute contraindications (such as certain hormone-dependent cancers and thrombotic conditions). Whether you are eligible for it is therefore always something to discuss with your doctor.