Study suggests early initiation of hormone therapy optimizes long-term health outcomes

Study suggests early initiation of hormone therapy optimizes long-term health outcomes

Menopause can be physically and emotionally stressful for women due to declining estrogen levels. For some, the use of hormone therapy has proven valuable in treating bothersome menopausal symptoms. A new study suggests that when a woman starts taking hormones has a big impact on longer-term health outcomes. The results of the study will be presented at the Menopause Society's 2025 Annual Meeting, October 21-25 in Orlando.

A large percentage of women experience menopausal symptoms, with hot flashes being the most common symptom. For many women, menopausal symptoms actually begin during perimenopause, the transition period before the last menstrual period. Perimenopause can last years. During this time, a woman's estrogen levels fluctuate and decline.

Estrogen therapy has proven to be one of the most effective and generally safest ways to treat bothersome menopausal symptoms. However, data on the impact of initiating hormone therapy during perimenopause on longer-term health outcomes are lacking. A new retrospective cohort analysis based on data from more than 120 million patient records aimed to compare the effect of estrogen therapy when started during perimenopause, postmenopause, or not at all. Specifically, the study examined the risk of breast cancer, heart attack and stroke in connection with estrogen therapy.

The results showed that perimenopausal women who had taken estrogen for at least 10 years before menopause had a significantly lower risk of breast cancer, heart attack and stroke compared to the other two groups - about 60% lower. Women who started estrogen therapy after menopause had a slightly lower risk of breast cancer and heart attack than women who never took hormones. However, these women were 4.9% more likely to have a stroke than the group who did not receive estrogens.

These results highlight the potential benefit of earlier initiation of estrogen therapy during perimenopause in minimizing risk and optimizing long-term health outcomes. More detailed results will be discussed at the Menopause Society 2025 Annual Meeting in the poster presentation entitled “The Timing of Estrogen Therapy: Perimenopausal Benefits and Postmenopausal Risks.”

"There has been a long-standing debate about whether and when estrogen therapy should be started, so the use of comprehensive electronic health records will hopefully help clarify this question," says Ify Chidi, lead author from Case Western Reserve University School of Medicine in Cleveland.

The goal of this study was to investigate whether estrogen therapy can do more than just relieve symptoms. The results suggest that early initiation may be a key factor in reducing morbidity. We hope that these results stimulate a broader discussion about prevention in women's health. If we better understand the effects of hormones during menopause, we can improve quality of life and reduce the burden of disease.”

Ify Chidi, Case Western Reserve University School of Medicine

Further clinical research is needed to confirm these results and to examine the long-term effects of estrogen therapy at different stages of menopause.

"The results of this study suggest a lower risk and potentially greater benefit of estrogen-based therapy when initiated in the perimenopause. While the observational study design is subject to known potential biases, such as healthy user bias, these results could pave the way for additional research on the risks and benefits of hormone therapy when initiated earlier in the menopause." will,” says Dr. Stephanie Faubion, medical director of the Menopause Society.

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