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Not all hormone therapy is created equal. A large retrospective study found that menopausal women on estrogen-only therapy had a modestly higher rate of autoimmune disease compared to those on estrogen-progestogen therapy. Experts say the findings call for more informed patient conversations — not a change in prescribing practice just yet.
A new retrospective cohort study presented at the 2026 Annual Meeting of The Menopause Society found that estrogen-only menopausal hormone therapy was associated with a slightly higher incidence of autoimmune disease compared to combined estrogen-progestogen therapy. Researchers from Drexel University College of Medicine analyzed data from over 109,000 propensity score-matched women aged 45–70, finding a composite autoimmune disease incidence of 4.9% vs. 4.5%, respectively.
Of 20 individual autoimmune diseases examined, five showed statistically significant differences: systemic lupus erythematosus, psoriasis, psoriatic arthritis, multiple sclerosis, and lichen sclerosus — all more common in the estrogen-only group. However, experts caution that the absolute differences were small, causation hasn't been established, and the findings shouldn't prompt changes in clinical practice.
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Why it matters: This study challenges the assumption that all menopausal hormone therapy carries the same immune-related risks. While it's hypothesis-generating rather than practice-changing, it opens the door for greater collaboration between menopause specialists and rheumatologists — and highlights the need for prospective trials to better understand how different hormone formulations interact with the immune system.
