A major new study from Denmark offers reassuring news for women considering hormone therapy to manage menopause symptoms.
Researchers found that menopausal hormone therapy—often called hormone replacement therapy (HRT)—was not linked to a higher risk of death, even with long-term use.
The findings were published in The BMJ and support current medical guidelines that recommend hormone therapy for women with moderate to severe menopausal symptoms who have no medical reasons to avoid it.
Hormone therapy is commonly prescribed to ease symptoms such as hot flashes, sleep problems, mood swings, and depression.
Despite its effectiveness, use of HRT has declined over the past two decades because of concerns about safety, especially fears that it might increase the risk of serious health problems.
Until now, there has been limited real-world evidence about its long-term effects on survival.
To investigate this question, researchers analyzed nationwide health records of more than 800,000 Danish women born between 1950 and 1977.
All participants were followed from age 45 for a median period of just over 14 years. Women with certain conditions—such as previous cancers, liver disease, or a history of blood clots—were excluded to ensure a clearer picture of the therapy’s effects.
Among the 876,805 women included in the main analysis, about 12% used hormone therapy at some point, while just over 5% died during the follow-up period.
Most women used hormone therapy for a relatively short time, with a median duration of 1.7 years.
At first glance, the raw data suggested that women who used hormone therapy had a higher death rate than those who never used it.
However, once researchers adjusted for important factors such as age, education, income, health conditions, and lifestyle differences, the apparent increase disappeared. In other words, hormone therapy itself was not associated with a higher risk of death.
The researchers also examined how long women used the therapy and found no increase in mortality risk even after 10 years or more of use. There were also no clear differences in deaths from heart disease, stroke, or cancer between women who used hormone therapy and those who did not.
Interestingly, the study found a survival benefit in a specific group of women who had undergone surgical removal of both ovaries for non-cancer reasons between ages 45 and 54.
Those who used hormone therapy had a 27% to 34% lower risk of death compared with women who did not receive treatment. The authors say this finding could influence future discussions about offering hormone therapy after such surgeries.
There was also some evidence that hormone therapy delivered through the skin, such as patches or gels, might be linked to slightly lower mortality than no treatment, though more research is needed to confirm this.
Because the study was observational, it cannot prove cause and effect. Still, its large size and comprehensive national data make the findings particularly reliable.
Overall, the results provide reassurance that hormone therapy can be a safe option for many women navigating menopause when used appropriately under medical guidance.
