Osteoporosis: Yes, menopausal hormone therapy can prevent bone loss and reduce fractures. It is reasonable mainly for women with troublesome menopausal symptoms, especially if they are younger than 60 or within about 10 years of menopause, and have low cardiovascular/VTE risk. It is not usually first-line solely to treat established osteoporosis when alternatives such as bisphosphonates, denosumab, or anabolic therapy are appropriate. Bone benefit declines after stopping, so a follow-on osteoporosis plan may be needed.

Coronary artery disease (CAD): No. Do not prescribe HRT to prevent or treat CAD. It has not shown cardiovascular protection in randomized trials and is generally avoided in women with known CAD or prior MI, stroke, or venous thromboembolism. The USPSTF recommendation notes no coronary benefit and recommends against using hormone therapy for primary prevention of chronic disease.

Practical point: if systemic HRT is being considered for menopausal symptoms, assess age/time since menopause, personal history of CAD/VTE/stroke/breast cancer, and whether the uterus is present. Women with a uterus need endometrial protection with a progestogen alongside systemic estrogen.

Recent reviews support the bone-density benefit but do not change the no-CAD-prevention conclusion: PMIDs 40421002 and 41307293.

HRT means hormone replacement therapy, now more often called menopausal hormone therapy (MHT).

It uses hormones that fall around menopause, mainly:

Types:

The main reason to use systemic HRT is bothersome menopause symptoms. It can also reduce bone loss and fracture risk, but it is not used to prevent or treat coronary artery disease. The Menopause Society overview describes these uses and risks.

Hot flashes are sudden episodes of intense warmth, usually felt over the face, neck, and chest.

They often cause:

They usually last 1 to 5 minutes. When they happen during sleep, they are called night sweats. They are common during perimenopause and menopause because changing estrogen levels affect the body's temperature regulation. The Menopause Society description calls these vasomotor symptoms.