Home›Rheumatology› Menopausal hormone therapy associated with modestly increased rheumatoid arthritis risk in meta-analysis
Menopausal hormone therapy associated with modestly increased rheumatoid arthritis risk in meta-analysisMenopausal hormone therapy linked to small increase in rheumatoid arthritis risk
Seminars in arthritis and rheumatismPublished April 1, 2026Study authors: Guimarães Camila, Balbinot Eduarda, Marçal Fernanda, Ferraz Sarah Dagostin, Uggioni Maria Laura Rodr…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider RA risk in individualized menopausal hormone therapy decisions based on observational association.
This systematic review and meta-analysis examined the association between menopausal hormone therapy use and rheumatoid arthritis incidence in postmenopausal women. The analysis included 5 studies representing 22,291,843 person-years of follow-up, though specific study designs and settings were not reported. The comparator group was not explicitly defined in the available data.
Overall, menopausal hormone therapy use was associated with a modestly increased risk of rheumatoid arthritis (Rate Ratio 1.15, 95% CI 1.10-1.21, p < 0.001). The association was stronger for current users (RR 1.18, 95% CI 1.00-1.37, p = 0.04) compared to former users, where the association was not statistically significant (RR 1.11, 95% CI 0.94-1.32, p = 0.20). Long-term use of ≥4 years showed greater risk (RR 1.19, 95% CI 1.07-1.33, p = 0.002).
Safety and tolerability data were not reported in the available evidence. The analysis showed no statistical heterogeneity (I² = 0%), but key limitations include the observational nature of the included studies, which cannot establish causation. Funding sources and conflicts of interest were not reported.
For clinical practice, these findings suggest that while the absolute increase in RA risk appears small, the widespread use of menopausal hormone therapy highlights the need for individualized risk-benefit assessment. Clinicians should be aware of this potential association, particularly when considering therapy for women with autoimmune susceptibility or family history of RA.
Researchers analyzed data from five previous studies to understand if using menopausal hormone therapy might affect a woman's chance of developing rheumatoid arthritis (RA). The studies followed postmenopausal women for a combined total of over 22 million person-years, looking at who used hormone therapy and who later developed RA.
They found that women using menopausal hormone therapy had a 15% higher rate of RA diagnosis compared to those not using it. The link was strongest for women currently using therapy and for those who had used it for four years or longer. The study did not report on specific safety concerns or side effects from the therapy itself.
It's important to know this was an observational analysis, meaning it can only show a link, not prove that hormone therapy causes RA. The actual increase in risk for any individual woman is likely very small. Women should discuss this information with their doctor as part of a personalized conversation about the benefits and risks of hormone therapy for their specific situation.
What this means for you:
Hormone therapy is linked to a small increase in RA risk; discuss your personal benefits and risks with your doctor.
OBJECTIVE: To assess the association between menopausal hormone therapy use and Rheumatoid Arthritis (RA) incidence among postmenopausal women.
METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. MEDLINE, Embase, and the Cochrane Library were searched up to October 2025 for observational studies evaluating menopausal hormone therapy use and RA risk. Pooled risk ratios (RR) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses explored current versus former use and therapy duration.
RESULTS: Five studies comprising 22,291,843 person-years of follow-up were included. Overall, menopausal hormone therapy use was associated with a modestly increased RA risk (Rate Ratio 1.15, 95% CI 1.10-1.21, p < 0.001; I² = 0%). Current users had higher risk (Rate Ratio 1.18, 95% CI 1.00-1.37, p = 0.04) compared with former users (Rate Ratio 1.11, 95% CI 0.94-1.32, p = 0.20). Long-term use (≥4 years) conferred greater risk (Rate Ratio 1.19, 95% CI 1.07-1.33, p = 0.002).
CONCLUSIONS: Current menopausal hormone therapy use is associated with a modestly higher incidence of rheumatoid arthritis. Although the absolute increase is small, the widespread use highlights the need for individualized risk-benefit assessment, especially in women with autoimmune susceptibility.
