What HRT Actually Does, and Where the Evidence Still Splits

This 2025 review pulled together the current evidence on menopausal hormone therapy, drawing on trials and guidelines through September 2025 to clarify a picture that has shifted considerably since the original fears of the early 2000s. It confirms hormone therapy as the most effective treatment for hot flushes, night sweats and vaginal symptoms, and finds it protects bone density, while being clear that it is not a treatment for preventing heart disease. The central, genuinely useful idea is the timing hypothesis: starting within ten years of menopause, generally with a lower-dose transdermal patch or gel rather than a tablet, carries a far more favourable balance of benefit to risk than starting a decade or more later. Because this is a narrative synthesis rather than a single trial, it reflects the current expert consensus rather than one new finding, and the authors are candid that risk still depends on the individual woman's age, health history and how the hormones are taken. For a woman weighing this decision, it reframes hormone therapy as neither a blanket yes nor no, but a choice whose safety profile depends heavily on when and how it begins, worth a specific conversation with a doctor rather than a general one.