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Updated October 9, 2026 · 6 min read

Hormone therapy beyond hot flashes:
what the research shows

Hot flashes are the symptom most people link with menopause, and the one hormone therapy was first tested for. Over decades, the trials also looked at bones, the heart, the vagina and sexual desire. Some of those results are strong. Others are thinner than the claims made about them, and a few were not what researchers expected.

Bones

In the Women’s Health Initiative combined trial, 16,608 women aged 50 to 79 with a uterus took daily conjugated estrogen with medroxyprogesterone, or placebo, for a median of 5.6 years. Confirmed osteoporotic fractures were 24% lower in the hormone group (hazard ratio 0.76). The 2022 position statement of The Menopause Society concludes that hormone therapy can prevent bone loss and fracture, and that the balance of benefit and risk is most favorable when treatment starts before age 60 or within 10 years of menopause onset.

Hot flashes and night sweats

Hot flashes are where hormone therapy works best. A Cochrane review of placebo-controlled trials (24 trials, 3,329 women) found hot flush frequency about 75% lower with hormone therapy than with placebo. Placebo groups also improved, so the gap between treatment and placebo is smaller than the drop from each woman’s starting point.

Timing

The timing hypothesis holds that the effects of hormone therapy on the heart depend on when treatment starts. In ELITE, 643 healthy women were randomized to oral estradiol or placebo, grouped by time since menopause. Women who started within 6 years of menopause had carotid thickening of 0.0044 mm a year on estradiol and 0.0078 mm a year on placebo. Women who started 10 years or more after menopause showed no difference. KEEPS, which started treatment in women 6 to 36 months past their last period, found no slowing of carotid thickening over four years with oral or transdermal estrogen. The question is not settled, and KEEPS is a reason to be careful with any claim that timing alone protects the heart.

Overall survival

Across the WHI randomized trials, followed for up to 18 years, hormone therapy was not associated with overall, cardiovascular or cancer mortality in women aged 50 to 79. The 2024 review by WHI investigators says the evidence does not support using estrogen-based therapy to reduce the risk of chronic disease such as heart disease, stroke, cancer or dementia. Living longer is not a benefit the trials support.

Vaginal symptoms

Vaginal estrogen is among the most effective treatments for genitourinary syndrome of menopause: dryness, burning, pain with sex and urinary symptoms that often outlast hot flashes. The 2022 position statement says it may be used at any age and for extended periods when needed.

Sexual desire

The 2019 Global Consensus considers testosterone evidence-based for women in one case only: postmenopausal women diagnosed with hypoactive sexual desire disorder after a formal biopsychosocial assessment. At physiological doses, the average gain over placebo was about one satisfying sexual event a month. The statement advises stopping if there is no benefit by 6 months, reports no safety data beyond 24 months, and does not recommend injectable, pellet or compounded testosterone.

What this does not say

  • The trial results come from the medicines and doses studied: conjugated estrogens, oral and transdermal estradiol, and medroxyprogesterone, in women who met each trial’s criteria. Our products are compounded or generic versions, so these numbers are averages for the studied medicines, not predictions for you.
  • The hot-flash figure is relative to placebo, and the fracture figure comes from one trial’s combined regimen. Neither is a promise about your bones or your symptoms.
  • Hormone therapy is approved for menopausal symptoms. Preventing heart disease, stroke, dementia or cancer is not an approved use, and the 2024 review does not support it.
  • The testosterone statement covers postmenopausal HSDD only, after formal assessment. It advises against injectable and compounded forms and has no safety data beyond 24 months.

How we use this

Our physicians start with your symptoms and history, then decide what the research means for you. Timing, route and dose are part of that decision, and we review them with you as you go.

We do not promise that hormone therapy extends life or prevents disease. We use the research to explain what treatment can do for the symptoms and risks you have, and what it cannot do.

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Sources

  1. 1.Cauley JA et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 2003;290:1729-38. JAMA
  2. 2.MacLennan AH et al. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev 2004. Cochrane
  3. 3.Hodis HN et al. Vascular effects of early versus late postmenopausal treatment with estradiol (ELITE). N Engl J Med 2016;374:1221-31. NEJM
  4. 4.Manson JE et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials. JAMA 2017;318:927-38. JAMA
  5. 5.Manson JE et al. The Women’s Health Initiative randomized trials and clinical practice: a review. JAMA 2024;331:1748-60. JAMA
  6. 6.The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022;29:767-94. Menopause
  7. 7.Davis SR et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab 2019;104:4660-6. JCEM
  8. 8.Harman SM et al. The Kronos Early Estrogen Prevention Study (KEEPS): what have we learned? Review of the trial results. PMC

All research