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The menopausal hormone therapy (MHT) risk–benefit profile has been at the centre of the debate that polarizes opinion between those who advocate the use of MHT and those who oppose it even before the publication of the original Women‘s Health Initiative (WHI) study in 2001. Whilst there is broad agreement around some of the key benefits of MHT there remains considerable difference about the interpretation of the risks in taking it. Revised data from the WHI and other randomized clinical trials since the publication of WHI together with various recent authoritative international position statements and recommendations since the last edition have helped to clarify some of the uncertainties and provide more robust evidence for clinical decision-making.