Real-world study on the effectiveness and breast safety analysis of hormone replacement therapy during menopause

Objective This real-world study evaluated the effects of 24-month menopausal hormone therapy (MHT) on bone mineral density (BMD), menopausal symptoms, and breast safety in postmenopausal women. Methods A total of 809 postmenopausal patients aged 40–60 years receiving MHT from June 2021 to June 2022 were enrolled. Kuppermann scores, BMD, and breast findings were assessed at baseline and at 6, 12, 18, and 24 months. Changes in outcomes were analyzed across time points, with Bonferroni correction for post hoc pairwise comparisons. Results Over the 24-month period, the prevalence of osteoporosis and low bone mass decreased significantly from 18.0 to 14.0% and from 27.4 to 21.4%, respectively ( p < 0.001). Significant differences in BMD were observed between baseline and each post-treatment time point (all p < 0.001), and BMD presented staged changes after treatment. The mean Kuppermann score demonstrated marked improvement, declining from 40.17 ± 6.04 at baseline to 11.38 ± 4.90 at 24 months ( p < 0.001), with the pace of symptom relief exhibiting distinct phases. No significant changes were observed in breast density, volume, or the prevalence of calcifications or masses (all p > 0.05). Conclusion The 24-month MHT regimen effectively improved BMD, alleviated menopausal symptoms in a stage-dependent manner, and demonstrated a favorable breast safety profile. These findings support the role of MHT in the comprehensive management of postmenopausal health.