{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:38:28Z","timestamp":1791441508508,"version":"4.3.3"},"reference-count":72,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>This study aims to synthesize contemporary evidence on the benefits, risks, and emerging options in menopausal hormone therapy (MHT), emphasizing the recent literature. A narrative review of peer-reviewed studies and guidelines (up to September 2025) from major databases (e.g., MEDLINE\/PubMed, Embase, Cochrane) was conducted, with emphasis on the last five years and qualitative synthesis. MHT provides the most effective relief of vasomotor symptoms and is the first-line treatment for genitourinary syndrome of menopause, particularly with the use of low-dose local vaginal estrogen preparations; it also prevents early postmenopausal bone loss and reduces fractures in selected cases. Cardiovascular prevention is not an indication. Benefit\u2013risk depends on timing, route, and dose. Initiation within 10 years of menopause as well as the use of transdermal estradiol at low\u2013moderate doses are favored when cardiometabolic or thrombotic risk is salient. In contrast, oral regimens\u2014particularly those using conjugated equine estrogens\u2014are associated with higher risks of venous thromboembolism and stroke compared with transdermal 17 \u03b2-estradiol, and risk also varies by the type of progestogen used. Effects on breast cancer risks are regimen-specific: neutral to favorable with estrogen-alone after hysterectomy, but increasing with longer use of combined therapy. While the absolute risk of ovarian cancer remains small, evidence for colorectal cancer remains mixed. MHT confers modest improvements in sleep, mood, intercourse, and quality of life. Estetrol (E4) shows anti-VMS efficacy at the minimum effective oral dose and favorable pharmacology, but conclusive data on its long-term cardiovascular, thrombotic, and breast safety are pending. MHT should be individualized appropriately based on the patient, timing, route, dose, and choice of progestogen. The lowest effective dose should be used, alongside periodically reassessing the therapy as new evidence, including emerging data on E4, emerges.<\/jats:p>","DOI":"10.3390\/ijms262211098","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:24:58Z","timestamp":1763375098000},"page":"11098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Menopausal Hormone Therapy\u2014Risks, Benefits and Emerging Options: A Narrative Review"],"prefix":"10.3390","volume":"26","author":[{"given":"Ana Maria","family":"Arnautu","sequence":"first","affiliation":[{"name":"Endocrinology Department, Bucharest University Emergency Hospital, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5376-7975","authenticated-orcid":false,"given":"Vanda Roxana","family":"Nimigean","sequence":"additional","affiliation":[{"name":"Department of Oral Rehabilitation, Faculty of Dentistry, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Alexandra","family":"Nacea-Radu","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Bucharest University Emergency Hospital, 050098 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5655-2694","authenticated-orcid":false,"given":"Dana Mihaela","family":"Tilici","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Bucharest University Emergency Hospital, 050098 Bucharest, Romania"},{"name":"Doctoral School, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Loreta","family":"Paun","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Bucharest University Emergency Hospital, 050098 Bucharest, Romania"},{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cCarol Davila\u201d, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mehta, J., Kling, J.M., and Manson, J.E. 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