Menopausal women using hormone therapy reported healthier diet, exercise and sleep habits than non-users in a study of more than 10,000 women.

The menopause transition is associated with a higher risk of chronic health conditions and symptoms including hot flushes and problems affecting the urinary and genital systems.

Hormone therapy is often used to manage these symptoms, but it remains unclear whether it affects health outcomes directly or indirectly through changes in health behaviours.

Previous research has produced mixed results, with some studies suggesting that postmenopausal women pay greater attention to maintaining a healthy lifestyle.

The cross-sectional analysis examined whether menopause status and hormone therapy use were linked to diet, physical activity and sleep duration.

A cross-sectional study assesses participants at one point in time. It can identify associations but cannot establish whether one factor directly caused another.

Diet, exercise and sleep are described as modifiable health behaviours because people may be able to change them to improve their health.

The researchers found that postmenopausal women who had never used hormone therapy reported eating less fruit and vegetables.

Women who had never used the treatment were also 19 per cent less likely to meet guidelines for muscle-strengthening activity.

Sleep duration was shorter among postmenopausal women who had never used hormone therapy.

Compared with premenopausal and perimenopausal women, the likelihood of meeting sleep guidelines was 14 per cent lower among never-users, 26 per cent lower among current users and 24 per cent lower among past users.

Perimenopause is the transitional period before menopause, when hormone levels and menstrual periods can change.

Researchers said these findings may be linked to higher levels of follicle-stimulating hormone among postmenopausal women who do not use hormone therapy.

They may also relate to lower levels of oestradiol, a form of oestrogen, which have previously been associated with poorer sleep.

Hot flushes and urogenital symptoms can also disrupt sleep, although hormone therapy may ease these symptoms.

Dr Stephanie Faubion, medical director for The Menopause Society, said: “This large observational study underscores that women who use hormone therapy tend to adopt overall healthier lifestyles.

“Although this association may partly reflect better symptom control enabling healthier behaviours, healthy-user bias is likely a significant contributor.

“Women who choose to use hormone therapy are often more proactive in their healthcare and may systematically differ from nonusers in socioeconomic resources, access to care, and health literacy.

“This largely explains why early observational studies of hormone therapy suggested cardiovascular benefits that were not confirmed in subsequent randomised, controlled trials.”

Spain will triple annual women’s health research funding to €18m under a programme focused on discrimination in medical research.

Spain’s Ministry of Science will increase investment in research and development projects focused on women’s health to €18m a year.

The initiative was announced on Monday by prime minister Pedro Sánchez during the presentation of Somos. Contamos: Fin de la discriminación de las mujeres en la investigación de la salud, which translates as We Are. We Count: Ending Discrimination Against Women in Health Research.

Sánchez said:

“This will boost research, diagnosis and treatment in areas that affect the lives of thousands of women in our country, who have not received the necessary attention.”

The plan is divided into three main areas.

These include a specific mission on women’s health through the centre for technological development and innovation, which will support companies and research centres working on research and development projects.

It also includes a new funding line for the Carlos III health institute and measures to build the research workforce in the field, including predoctoral contracts for projects focused on women’s health.

Sánchez said conditions such as endometriosis reflected discrimination faced by women in healthcare.

Endometriosis is a condition where tissue similar to the lining of the womb grows outside the uterus, often causing severe pain and, in some cases, fertility problems.

The prime minister said the condition affects one in seven women and can take a decade to diagnose.

He said:

“This cannot be allowed in Spain today.”

Sánchez added:

“If a disease affected one in seven men, causing chronic pain, difficulty working, and fertility problems, would we accept a decade-long delay in diagnosis? The answer is obvious: certainly not. So it’s high time we said ‘no’ with the same clarity when we talk about diseases that affect millions of women.”

Other diseases where diagnosis and treatment suffer from a lack of a gender perspective include chronic pain, autoimmune and thyroid diseases, cardiovascular and mental health conditions, menopause and hormonal imbalances.

Autoimmune diseases occur when the immune system mistakenly attacks the body, while thyroid diseases affect a gland in the neck that helps regulate metabolism, energy and hormones.

Sánchez said:

“There can be no equality while science continues to respond better to some lives than to others.”

The prime minister also addressed the delay in diagnosing women.

He said:

“It is a paradox that says a lot about our past, that challenges our present, but that also drives us to change the future, including through politics.”

Women who do not use menopausal hormone therapy have a greater risk of developing osteopenia or osteoporosis, conditions that weaken bones and can lead to fractures, disability and loss of independence, new research suggests.

The retrospective cohort study included 387 postmenopausal women who underwent DXA scans between 2021 and 2025. A DXA scan is an imaging test used to measure bone mineral density.

Participants were classed as menopausal hormone therapy users, who made up 33 per cent of the group, or non-users, who made up 67 per cent.

Low bone mineral density was defined as osteopenia, where bones are weaker than normal, or osteoporosis, where bones become more fragile and more likely to break.

Women taking menopausal hormone therapy had about 69 per cent lower risk of low bone mineral density in the spine and hip compared with those not using it.

The association remained after researchers accounted for age, time since menopause, vitamin D levels, smoking and other health conditions.

Diego Espinoza-Peralta, vice president of the Mexican Society of Nutrition and Endocrinology and principal investigator at Investigación Médica Sonora, said: “For years, many women have avoided menopausal hormone therapy because of safety concerns and warning labels.

“This study revisits that narrative and shows that menopausal hormone therapy may have an important added benefit: protecting bone health. That shifts the conversation from ‘avoid if possible’ to ‘reconsider in the right patient.’

“In simple terms: menopausal hormone therapy appears to independently protect bones, not just by coincidence.”

The findings suggest hormone therapy could help some women find relief from menopausal symptoms while preventing bone loss or lowering fracture risk.

Espinoza-Peralta said: “Clinicians may begin to weigh its benefits more carefully, especially in women early after menopause, potentially improving long-term health and quality of life.”