Medical Bulletin 25/July/2025

A new study published in The Lancet Healthy Longevity has found that the bone fracture protection provided by menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT), disappears within a year of stopping treatment. The study, also revealed that many women experience an elevated fracture risk in the years following discontinuation compared to those who have never used menopausal hormone therapy before risk levels eventually drop below those of never-users.

During menopause, women experience a natural decline in hormone levels, particularly oestrogen, which not only causes symptoms like hot flashes and mood changes, but also leads to weakened bones. menopausal hormone therapy is known to reduce fracture risk by supplementing oestrogen levels, but due to potential risks like breast cancer and blood clots, long-term use is generally discouraged. Until now, the long-term effects on fracture risk after stopping MHT had remained unclear and inconsistently reported.

To address this gap, researchers analyzed data from six million women across 2,000 general practice surgeries in the UK. They identified women with first fracture records and matched them with similar women without fractures, comparing their histories of menopausal hormone therapy use. The study tracked outcomes for up to 25 years, making it one of the most comprehensive investigations to date.

Lead author Dr Yana Vinogradova said, “For most women, the bone protective effect of menopausal hormone therapy use disappears completely within about one year of treatment being stopped, then their fracture risk rises compared to never users, peaking after about three years, before declining to become again equivalent to never users – about 10 years after discontinuation – and then again continuing to decline relative to never users. So, even after stopping menopausal hormone therapy, women should benefit from notably reduced fracture risk in their later decades.”

“These novel findings may also usefully stimulate further clinical and biological research into these treatments,” adds Dr Vinogradova.

Reference: Discontinuation of menopausal hormone therapy and risk of fracture: nested case–control studies using routinely collected primary care data, Vinogradova, Yana et al. The Lancet Healthy Longevity, Volume 0, Issue 0, 100729

Could Smoking and Vaping Be Making Teen Mental Health Worse?

Adolescents who use e-cigarettes or conventional tobacco products are significantly more likely to report symptoms of depression and anxiety than their non-using peers, according to a new study published in PLOS Mental Health. The research, led by Noor Abdulhay of West Virginia University, adds to growing evidence of a link between youth tobacco use and mental health struggles.

With rising rates of anxiety, depression, and suicide among U.S. teens and shifting patterns in tobacco use understanding how these factors intersect has become increasingly urgent.

In this new analysis, researchers examined data from the 2021–2023 National Youth Tobacco Survey, which includes responses from 60,072 middle and high school students across the United States. The survey assessed students’ use of tobacco products, including e-cigarettes and conventional tobacco products (CTPs) such as cigarettes, cigars, hookah, and pipes, as well as self-reported symptoms of depression and anxiety.

Of all respondents, 21.37% reported using some form of tobacco. Specifically, 9.94% used only e-cigarettes, 3.61% used only conventional tobacco products, and 7.80% used both. When it came to mental health, 25.21% of participants reported symptoms associated with depression, while 29.55% experienced anxiety symptoms.

Compared to adolescents who had never used tobacco, those who used e-cigarettes or conventional tobacco products were more likely to report symptoms of depression and anxiety. The highest risk was observed among youth who used both product types.

While the study does not establish a direct cause-and-effect relationship, the findings underscore a clear and concerning association. “While causality cannot be determined, the results from this study showed that all forms of tobacco use were significantly associated with mental health issues,” the authors stated.

The researchers emphasize the need for continued promotion of mental health support among teens and the implementation of targeted interventions to reduce all forms of tobacco use.

Reference: Abdulhay N, Wiener RC, Wen S, Gibbs BB, Bhandari R (2025) Mental health outcomes associated with electronic cigarette use, combustible tobacco use, and dual use among U.S. adolescents: Insights from the National Youth Tobacco Survey. PLOS Ment Health 2(7): e0000370. https://doi.org/10.1371/journal.pmen.0000370