HRT in women does not increase total mortality and markedly reduces it for some.

Adapted from BMJ 21-28 Feb 2026 Menopausal hormone therapy and long term mortality by Mikkelsen, Bergholt and Scheller.

Is HRT a good thing or a bad thing? Most research veers towards positivity but there are occasional surges of bad reports in the press that can put both women and doctors off. The most telling statistic is the effect on the total mortality rate, rather than the effects on specific disease processes.

In this Danish cohort study, all women born between 1950 and 1977 who were alive aged 45 were included in the study. They were followed up from their 45th birthday till 31st July 2023. Of the original 969,424 women, 92,619 were excluded from further study because of thrombophilia, liver disease, arterial or venous thrombosis, breast cancer, endometrial cancer, ovarian cancer, earlier use of HRT or earlier bilateral ovary removal.

They then looked at who didn’t get HRT, who did, and what type. They looked at the main cause of death and any secondary factors listed in the death certificates. 5.4% of the women died during this period of observation. Researchers were looking at cardiovascular causes, cancer, and other causes. They then adjusted for age, calendar year, parity, educational qualification, income quartile, country of birth, diabetes, high cholesterol, hypertension, atrial fibrillation, valvular disease, heart failure and three or more hospital contacts between 44 and 45 years of age. The average follow up time was 14.3 years.

They found that menopausal hormone therapy was not associated with increased mortality.

In addition, women who had undergone bilateral oophorectomy between 45 and 55 years of age had a 27-34% lower mortality than women who did not. My comment: This is a whopping reduction! I was delighted to see this as I’m in this group of women. For a start, removing potentially cancer developing organs will reduce mortality. Oestrogen only HRT is also known to reduce breast cancer onset to a mild degree, and if given within ten years of the menopause, also reduces arteriosclerosis considerably.

104,086 women took prescribed HRT compared to 772,719 who didn’t. This was only 11.9%. I’m surprised the number of HRT users was so low. I offered it to all menopausal women who didn’t have a contra-indication to it.