• “MHT, including tibolone and the combination of conjugated equine estrogens and bazedoxifene (CE/BZA), is the most effective treatment for vasomotor symptoms (VMS) associated with menopause at any age, but benefits are more likely to outweigh risks if initiated for symptomatic women before the age of 60 years or within 10 years after menopause”.²

• Much of the information regarding breast cancer risk and MHT reported in this paper is not new…
• It is important to note that, because of when the data included in this report was collected, most of the MHT regimes were different from those used today
• This paper provides an important public health message about obesity and breast cancer risk…”.⁴

Women enter menopause across a range of ages, with diverse symptoms and health risk profiles. The International Menopause Society advocates the comprehensive assessment of women, including attention to modifying risk factors for chronic disease such as being overweight or obese, the importance of which have been highlighted in this Lancet paper. The benefits and risks of MHT differ according to the timing of menopause such that individualisation of therapy is essential. As prescribing practices have changed significantly over the last decade, further research is needed to determine the impact of currently recommended regimens”.⁵

• “MHT, including tibolone and CE/BZA, is effective in the prevention of bone loss in postmenopausal women
• MHT has been shown to significantly lower the risk of hip, vertebral and other osteoporosis-related fractures in postmenopausal women
• MHT, including tibolone, can be initiated in postmenopausal women at risk of fracture or osteoporosis before the age of 60 years or within 10 years after menopause”.⁷

• “For women who initiate HT more than 10 or 20 years from menopause onset or when aged 60 years or older, the benefit-risk ratio appears less favorable than for younger women because of greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia
• Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent hot flashes, quality-of-life issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks”.⁸

• “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.⁹