Key result
HRT cardiometabolic effects vary substantially by administration route, timing of initiation, and progestogen type.
Why the study?
With increased HRT prescription rates and emerging evidence on routes, timing, and outcomes like MASLD, understanding HRT's impact on cardiometabolic risk is critical.
Does hormone replacement therapy impact cardiometabolic risk and disease development in women experiencing menopausal symptoms?
Does hormone replacement therapy impact cardiometabolic risk and disease development in women experiencing menopausal symptoms?
Understanding the nuanced cardiometabolic effects of different HRT regimens is necessary to facilitate informed decision-making for managing menopausal symptoms while considering cardiovascular risk.
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Tailor HRT selection by route, timing, and progestogen to balance cardiometabolic effects; extends prior syntheses but leaves definitive guidance open for targeted trials.
Existing evidence suggests that HRT is likely to impact the development of metabolic risk factors including visceral fat accumulation, adverse changes in lipid profile, blood pressure and glycaemic control. Findings from randomised controlled trials have refined our understanding of the impact of HRT on cardiometabolic outcomes including coronary heart disease and stroke. Furthermore, recent research has highlighted the impact of the menopause on the development and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) that has been poorly studied in the context of HRT. The route of oestrogen administration, timing of initiation and type of progestogen are all likely to affect the impact of HRT on many of these outcomes. There has recently been extensive media interest in HRT in some countries resulting in increased prescription rates. Understanding the impact of HRT on cardiometabolic risk is therefore particularly important. In this narrative review, we discuss the existing evidence and clinical guidelines on the effect of HRT on cardiometabolic risk factors and the risk of coronary heart disease, stroke and MASLD, highlighting areas of uncertainty and priorities for further research.
Dong et al. (2026) conducted a review in Menopausal symptoms and cardiometabolic risk. Hormone replacement therapy was evaluated. Hormone replacement therapy impacts metabolic risk factors and cardiometabolic outcomes, with effects heavily modified by the route of oestrogen administration, timing of initiation, and type of progestogen.
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