Zhang GQ, Chen JL, Luo Y, et al. - An umbrella review was conducted to comprehensively summarize evidence on the benefits and harms of menopausal hormone therapy (MHT) across diverse health outcomes among women.

• A total of 60 published systematic reviews of MHT use in menopausal women were included; these involved 102 meta-analyses of randomized controlled trials and 38 of observational studies.

• The evidence was synthesized on 102 health outcomes.

• A complex balance of benefits and harms was revealed for MHT; for instance, MHT was not only linked with reduced risks of bone fracture, diabetes mellitus, and esophageal, gastric, and colorectal cancer besides alleviation of menopausal symptoms, but also with raised risks of stroke, venous thromboembolism, gallbladder disease, and breast and ovarian cancer.

• The available clinical data that support reduction in the risk of coronary heart disease and all-cause mortality in women aged < 60 years or within 10 years from menopause (known as the “timing hypothesis”) in correlation with receiving MHT, were only suggestive.

• Systematic reviews included in this work were of overall moderate to poor quality.