MHT is primarily used for symptomatic relief of vasomotor symptoms and genitourinary syndrome of menopause, not for dementia prevention. At the time of this guideline update, no dedicated WHO guideline on the management and treatment of menopausal symptoms was available, although development of such guidelines will be initiated soon. y MHT is used primarily for symptomatic relief (including vasomotor symptoms and genitourinary syndrome of menopause), not for dementia prevention. Initiating MHT more than 10 years after menopause is associated with a less favourable benefit–risk profile compared with earlier initiation. The evidence reviewed for this guideline therefore does not apply to women aged in their 40s and 50s, who represent the typical population seeking treatment for menopausal symptoms. y The negative recommendation in this guideline applies specifically to women aged 65 years and older, irrespective of MHT type. It reflects the age group for which evidence was available and assessed through the GRADE process (the evidence profile can be found in the Web Annex H). y Evidence considered by the 2024 National Institute for Health and Care Excellence (NICE) Guideline Committee suggests that combined MHT, when initiated after the age of 65 years, may increase the risk of dementia, whereas estrogen-only MHT does not appear to affect dementia risk (159). Accordingly, the NICE guideline recommends that neither combined nor estrogen-only hormone replacement therapy should be offered for the purpose of preventing dementia (159). The NICE guideline also provides detailed evidence on how different types of MHT influence other health outcomes, including breast and ovarian cancer, coronary heart disease and stroke (159). Meanwhile, in the USA, the boxed safety warnings for risks associated with MHT products are being updated (170). y MHT is typically prescribed to manage and relieve current menopausal symptoms, not for the prevention of dementia or other long-term conditions. In routine practice, women and their health care providers should jointly consider the full balance of benefits and risks of MHT. Benefits include effective treatment of hot flushes and night sweats, and prevention of osteoporotic fractures. Depending on the formulation, duration of use and age at initiation, risks may include venous thromboembolism, stroke and certain types of cancer, particularly breast cancer. y Risks and benefits should be discussed, especially for those initiating MHT at the age of 65 years or older, or those considering long-term use. y Although the impact of MHT on dementia risk appears to be trivial or uncertain, the risk of serious non-cognitive harms, in particular certain types of cancer, is likely to be clinically significant, particularly with combined estrogen–progestogen therapy. y No recommendation is made for MHT for the purpose of dementia risk reduction in women aged under 65 years, because there is currently insufficient evidence to advise for or against its use for this purpose. Additional high-quality research is needed in this area. y MHT is just one component within the broader landscape of women’s health. The higher burden of dementia in women reflects the interaction of multiple biological, social and environmental determinants, with MHT representing only one of many modifiable factors.