When to initiate hormone therapy, how it should be delivered, associations with metabolic syndrome, gut issues and more were presented.
The 2025 annual meeting of The Menopause Society was held at the end of October.
While the full research won’t be published until later in the year, here are some of the interesting highlights that have been released.
EARLIER ESTROGEN THERAPY SIGNIFICANTLY REDUCES THE RISK OF BREAST CANCER, HEART ATTACK AND STROKE
Retrospective cohort analysis of more than 120 million patient records compared the impact of estrogen therapy initiated in perimenopause, after menopause or not initiated.
Perimenopausal women who had used estrogen for at least 10 years before menopause had around 60% lower odds of developing breast cancer, heart attack and stroke than both other groups.
Estrogen therapy initiated after menopause was associated with slightly lower odds of breast cancer and heart attack than women who did not start hormone therapy.
However, they were 5% more likely to experience stroke.
There has been limited data regarding the long-term impact of initiating hormone therapy in perimenopause, but many women begin experiencing menopause symptoms during this time.
The research team wanted to explore whether estrogen therapy could do more than relieve symptoms, said lead author Ify Chidi, MPH, from Case Western Reserve University School of Medicine in Cleveland.
“The results suggest that early initiation could be a key factor in reducing morbidity,” she told media.
“Hopefully, these results start a larger conversation about prevention in women’s health. If we can better understand the effect of hormones throughout menopause, we can improve the quality of life and reduce disease burden.”
MODE AND TIMING OF THERAPY DELIVERY MAY IMPACT MENTAL HEALTH
Researchers have found that transdermal hormone therapy may be associated with a lower incidence of anxiety and depression than oral hormone therapy.
The health outcomes of nearly 4000 postmenopausal women were used to compare oral and transdermal hormone therapy.
For obesity, cardiovascular disease and Alzheimer’s disease, no significant differences were found between the routes of administration.
Women with established CVD risk factors such as premature menopause, diabetes, obesity, hyperlipidemia, hypertension, tobacco use and family history of heart disease were excluded.
Hormone therapy is not a one-size-fits-all treatment, Dr Xuezhi (Daniel) Jiang, Professor of Obstetrics and Gynaecology at Drexel University College of Medicine and Reading Hospital at Tower Health, told media.
“The choice of route of administration should be individualized and made through shared decision-making, particularly for women with a history of depression,” he said.
Another study found that estrogen-based hormone therapy did not consistently reduce anxiety symptoms among midlife women but did for some.
Researchers found modest benefits in perimenopausal women and women who had had their final menstrual period within the last few years, especially if they were symptomatic.
The route, dose and baseline severity of symptoms was found to influence the responses to treatment as well.
Researchers assessed seven trials, totalling more than 1,200 premenopausal and postmenopausal women, and observation studies which captured around 175,000 individuals spanning the midlife years.
“Women are often asking if menopause hormone therapy will improve their anxiety symptoms, and we wanted to synthesise the information to counsel patients with evidence-based information,” Carys Stefanie Sosea, lead author from McMaster University in Canada, told media.
EARLY NATURAL MENOPAUSE LINKED WITH HIGHER METABOLIC RISK
Nearly 14% of women who experienced early menopause developed metabolic syndrome, compared to less than 11% for late menopause.
The electronic health record data of more than 230,000 women aged 30-60 years revealed a 27% increased relative risk associated with early natural menopause.
The study excluded women who were on hormone therapy and menopause induced by hysterectomy, bilateral oophorectomy, radiation and chemotherapy.
Associations remained significant when confounders such as medications, race and BMI were adjusted for.
Metabolic syndrome carries serious risks, and prevention or early intervention are critical for avoiding permanent cellular damage and potentially life-threatening outcomes, authors noted.
The decline in estrogen levels reduces protection against metabolic conditions. Midlife women who are not receiving estrogen-based hormone therapy are at an increased risk for metabolic disorders.
“Our findings show that age at natural menopause isn’t just a reproductive milestone—it’s a powerful indication of long-term cardiometabolic risk,” Dr Shefali Setia Verman, study author and Assistant Professor in the Department of Pathology and Laboratory Medicine and the Division of Informatics at the University of Pennsylvania, told media.
“Recognising early menopause as a marker for metabolic syndrome gives clinicians a crucial window to identify at-risk women sooner and intervene earlier to prevent heart disease, diabetes and other complications.”
SCREENING FOR DRY EYE DISEASE SHOULD BE ROUTINE
Analysis of 3500 women with a mean age of 52 years revealed a higher prevalence of dry eye disease in postmenopausal women than perimenopausal women.
Lead author Debora Yankelevich, a researcher from Hospital de Clinicas Jose de San Martin in Argentina, told media that clinicians should add dry eye disease to routine questionnaires.
While considered a relatively common disease, especially among older women, dry eyes disease in menopause is often missed.
Dry eye disease is not only uncomfortable, but it can also lead to infections and surface damage if left untreated.
More than 57% of menopausal women in the study had dry eye disease, compared to 53% of premenopausal women.
DIGESTIVE ISSUES ARE UNDERDIAGNOSED AND UNDERTREATED
Of 600 women in the UK aged 44 to 73, almost 95% reported digestive issues. Bloating (77%), constipation (54%), stomach pain (50%) and acid reflux (49%) were the most common.
More than 80% reported digestive issue onset or worsening of symptoms at perimenopause or menopause.
While more than half of the cohort had sought professional support for these issues, nearly 60% of them found it to be inadequate. Only a third of the cohort received a formal IBS diagnosis.
Nine in 10 women in the study suffering from digestive issues had tried self-management strategies such as dietary changes, stress management and supplements.
More than half experienced symptoms daily or weekly and reported a regular or significant impact on their quality of life.
“Digestive health problems at midlife are often brushed aside, yet our research shows they are both widespread and impactful for women,” Nigel Denby, London dietitian and lead author, told media.
“By raising awareness of this hidden burden, we hope to encourage healthcare professionals to ask the right questions, validate women’s experiences, and work towards better support and treatment options during menopause.”
HORMONE THERAPY MAY INCREASE RISK OF 15 AUTOIMMUNE DISEASES
Researchers have found that hormone therapy users had a higher incidence of autoimmune diseases at 5 years, 10 years and across the full postmenopausal period than non-users.
Looking at 17 individual autoimmune conditions over the full postmenopausal period, statistically significant increases in risk were found for all except Graves’ disease and autoimmune hepatitis.
Nearly 1.8 million women were included, with a mean age of 60 years.
Autoimmune diseases disproportionately affect women, with notable incidence increases following menopause. Researchers said this suggests a potential role of sex hormones in immune regulation.
While the study found a statistical link between hormone therapy and autoimmune diseases, the increase in absolute risk was relatively small and varied by condition, Dr Xuezhi (Daniel) Jiang, Professor of Obstetrics and Gynaecology at Drexel University College of Medicine, told media.
“Hormone therapy remains a safe and important option for many women when used appropriately but, like any treatment, it should be individualised while we await more research on its possible links to autoimmune disease,” he said.
