Patient Education
The long-term benefits and risks of hormone therapy
Most women hear about hormone therapy for the things they can feel — hot flashes, night sweats, sleep. But some of the biggest long-term benefits are quieter. They show up as things that don’t happen. Fractures you never break. Diabetes you never develop. Years added to your life. This page walks through what the biggest studies have found — and what it might mean for you.
Benefits you can’t feel
The most-talked-about reasons for hormone therapy are the ones you notice: fewer hot flashes, better sleep, less brain fog. Those matter. But they’re not the whole story.
Some of the biggest long-term benefits show up as absences — things that don’t happen:
- A hip fracture you never have in your 70s
- A diabetes diagnosis you never receive
- A memory that stays sharp instead of fading
- A heart attack that never comes
- Extra years of life
You’ll never wake up one morning and notice a fracture that didn’t happen. These “silent benefits” only show up when researchers compare thousands of women over years — one group on hormone therapy, one group not — and count what didn’t happen in each. That’s exactly what the studies on this page did.
Cases
Attacks
Health
Urinary
The numbers on this page come from studies of tens of thousands of women averaged together. They tell us what happens on average, in a group. They don’t tell us exactly what will happen to you.
Some women will get most of these benefits. Some will get fewer. Which ones matter most for you depends on your personal and family history — a mother with early osteoporosis, a father with dementia, a strong heart disease pattern in the family — and on what you’re trying to protect against.
The way to think about it: hormone therapy tips the odds in your favor across several areas of health at once, if you start in the right window. It doesn’t guarantee any particular outcome. But the odds it tips are real.
When you start matters — a lot
The single biggest lesson from decades of research on hormone therapy is this: when you start matters as much as whether you start. If you begin hormone therapy within about 10 years of menopause, or before age 60, the benefits are strong and outweigh the risks for most healthy women. If you wait longer — especially past age 65 — the picture changes, and some benefits actually reverse.
This is one of the reasons it’s worth having the conversation now, even if your symptoms feel manageable. The timing window doesn’t wait for you to be sure.
Starting hormone therapy in this window offers the strongest benefits for your heart, bones, brain, and lifespan.
Some benefits become smaller. A few — like the protection against dementia — can actually reverse if started after 65.
In 2025, the FDA began removing the “black box” warnings from menopausal hormone therapy products. Their reasoning: for most women who start within 10 years of menopause, the benefits — including reduced deaths, fractures, heart attacks, cognitive decline, and Alzheimer’s disease — outweigh the risks.13
What long-term studies have found
The numbers below come from the largest hormone therapy studies ever done — including the Women’s Health Initiative (a study of more than 27,000 women), plus major evidence reviews published in 2022 and 2026. Each visual comparison shows what happens on average, if a group of women takes hormone therapy versus if they don’t.
Keep in mind: these are group averages. Your personal history, your genetics, and your specific risks may make one of these benefits matter much more to you than another.
Hormone therapy is FDA-approved for preventing osteoporosis (thinning bones after menopause) and is one of the most effective ways to lower fracture risk.4,5 The Women’s Health Initiative showed about 22 to 27 percent fewer fractures in women on hormone therapy.6,7
An important caveat: bone benefits depend on continuing hormone therapy. Research called the NORA study found that women who stopped hormone therapy more than 5 years ago had bone density and fracture risk about the same as women who never used it. Short-term use (5 years or less) for symptom relief alone may not protect your bones long-term.10
Hormone therapy meaningfully lowers the chance of developing diabetes after menopause. The evidence includes two large arms of the Women’s Health Initiative plus a big review of 107 trials.7,11,12
For women who start hormone therapy within 10 years of menopause, the chance of coronary heart disease drops by about half.17
Starting hormone therapy early appears to protect against dementia and cognitive decline. The FDA has reviewed evidence showing that hormone therapy started within 10 years of menopause may reduce Alzheimer’s disease risk by up to 64% and cognitive decline by up to 50%.13
The same evidence base that shows a brain benefit from early hormone therapy also shows something important: starting hormone therapy after age 65 is linked to an increased dementia risk (about double the risk in the WHI data).7 This is the clearest reason why timing isn’t just a preference — it’s a decision that changes what direction the benefit goes.
The long-term follow-up of the WHI found that women who started hormone therapy at younger ages had a 21 to 30 percent lower chance of death from any cause. Over a year, that comes out to about 2 to 2.5 fewer deaths per 1,000 women.15,16
Women on estrogen-plus-progestin therapy in the WHI had about 38% fewer colorectal cancers, or about 6 fewer cases per 10,000 women per year.7,12 This benefit was not seen with estrogen-only therapy, so it appears to be linked to the progestogen component.11
Hormone therapy is the most effective treatment for the vaginal dryness, painful sex, and recurrent urinary tract infections that many women develop after menopause. Both low-dose vaginal estrogen and systemic hormone therapy significantly improve quality of life and sexual function.9,14
A recent study: testosterone after a hip fracture
A newer study looked at whether adding testosterone to a rehab program helps older women recover after a broken hip. It’s a good example of how the research on hormones continues to evolve.
The STEP-HI Trial
What they did. Researchers at 8 US sites randomly assigned women aged 65 and older, all recovering from hip fracture surgery, into three groups for 24 weeks: (1) supervised exercise plus testosterone gel, (2) supervised exercise plus placebo gel, or (3) home exercise plus health education. Everyone got calcium, vitamin D, and dietary counseling.18,19
What they found. The main test was whether adding testosterone would improve women’s ability to walk a longer distance. It didn’t — testosterone didn’t beat exercise alone for walking distance.18
The interesting part. Testosterone did seem to help with strength-based movements — things like standing up from a chair — and women on testosterone used walkers and canes less. The researchers concluded testosterone may help strength and functional recovery more than endurance, and that in this trial, exercise alone may have been strong enough to mask a smaller testosterone effect.18
What other studies show. A 2025 review of 9 similar studies (466 women total) found that testosterone-type therapy after hip fracture did increase hip bone density and improved patient-reported function. Side effects were mild and short-lived.20 A separate review of testosterone around orthopedic surgery reported similar improvements.21
What this means for you
The long-term research supports hormone therapy for healthy women who have menopausal symptoms and start within about 10 years of menopause or before age 60. For most women in that group, the benefits are meaningful and outweigh the risks.
But this decision is yours, and it’s individual. A few things worth thinking through:
- What are you trying to protect against? A woman with early osteoporosis in her family may weigh the bone benefit heavily. A woman with dementia in the family may weigh the cognitive benefit heavily. You may not know which benefits will end up mattering most to you — but knowing your family history helps you think about it.
- Timing changes the direction of some benefits. Starting after age 65 turns the brain-health benefit into a brain-health risk. This isn’t a small detail — it’s a change in direction.7
- Some benefits only last while you’re taking it. Bone protection in particular fades within about 5 years of stopping. So if long-term bone protection matters for you, that has to be part of the plan from the start.10
- You won’t feel most of the benefits happening. That’s the nature of prevention — it’s measured in things that don’t happen, over years. If you’re used to judging medications by how quickly you feel them working, this one is different.
The specifics of what’s right for you depend on your symptoms, your personal and family history, and what matters most to you. This page is a starting point — the rest is a conversation to have with us.
What to remember
- Hormone therapy has long-term benefits most women haven’t heard about — things that go well beyond hot-flash relief.
- Many of those benefits are silent: fractures that don’t happen, diabetes that doesn’t develop, memory that stays sharp. You won’t feel them working — but the research counts them.
- The biggest documented wins: fewer fractures, less diabetes, healthier heart, brain protection, and longer lifespan.
- Timing matters more than most people realize. Starting within 10 years of menopause or before 60 gets the most benefit; starting after 65 can flip some benefits into risks.
- Some benefits (like bone protection) only last while you’re on treatment.
- Every woman is different. These are group averages — your personal and family history shape which benefits matter most for you.
- The 2025 FDA update recognized this evidence and moved to remove the black box warnings.13
Research
Long-term benefits & timing of hormone therapy
- The Women’s Health Initiative trials of menopausal hormone therapy: lessons learned. Menopause. 2020.
- Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007.
- Approach to managing a postmenopausal patient. The Journal of Clinical Endocrinology and Metabolism. 2020.
- Estrogens, conjugated (oral). FDA Drug Label. Food and Drug Administration. 2026.
- Conjugated estrogens / medroxyprogesterone acetate oral (Premphase). FDA Drug Label. Food and Drug Administration. 2026.
- Bofill Rodriguez M, Yong LN, Mirkov S, et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews. 2026.
- Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2022.
- Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2019.
- The 2022 hormone therapy position statement of the North American Menopause Society. Menopause. 2022.
- Recency and duration of postmenopausal hormone therapy: effects on bone mineral density and fracture risk in the National Osteoporosis Risk Assessment (NORA) study. Menopause. 2003.
- Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: US Preventive Services Task Force recommendation statement. JAMA. 2017.
- Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: US Preventive Services Task Force recommendation statement. JAMA. 2022.
- FDA initiates removal of “black box” warnings from menopausal hormone replacement therapy products. Department of Health & Human Services. 2025.
- Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice. Human Reproduction Update. 2021.
- Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: the Women’s Health Initiative randomized trials. JAMA. 2017.
- Hormones and aging: an Endocrine Society scientific statement. The Journal of Clinical Endocrinology and Metabolism. 2023.
- Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews. 2015.
Testosterone after hip fracture (STEP-HI trial)
- Binder EF, Bartley JM, Berry SD, et al. Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture: The STEP-HI Randomized Clinical Trial. JAMA Network Open. 2025.
- Binder EF, Christensen JC, Stevens-Lapsley J, et al. A Multi-Center Trial of Exercise and Testosterone Therapy in Women After Hip Fracture: Design, Methods and Impact of the COVID-19 Pandemic. Contemporary Clinical Trials. 2021.
- Box MW, O’Connor KP, Major J, et al. Anabolic-Steroid Therapy After Geriatric Proximal Femur Fracture: A Level I Evidence Systematic Review and Meta-Analysis of Bone Density, Functional Recovery, and Safety. Osteoporosis International. 2025.
- Flynn ME, Cohen MF, O’Brien EJ, Domb BG. Perioperative Testosterone Supplementation Improves Outcomes of Orthopaedic Surgeries: A Systematic Review of Heterogeneous Studies. Arthroscopy. 2024.