For most healthy women starting before 60 or within ten years of menopause, yes, and that is the position of the major professional bodies. Outside that window, or with a significant personal history, the balance shifts and the decision becomes individual rather than general.
What improves
Atlanta safety review: the benefit side
Vasomotor symptoms respond to systemic estrogen better than to anything else available, so that is where a Atlanta assessment of expected benefit begins. Vasomotor symptoms respond better to systemic estrogen than to any other treatment, and it is FDA-approved as first-line for that reason. Most women see a clear reduction within four to twelve weeks.
Bone loss is prevented and fracture rates fall. That effect is well established and is one of the few benefits that persists as a measurable population-level outcome rather than a symptom score.
Vaginal and urinary symptoms improve, sleep improves where night sweats were disrupting it, and mood and joint symptoms improve for many women, though the evidence there is less firm than for flashes and bone. Related reading: safety and risks, hot flashes and night sweats and joint and muscle pain go further into it. We say which of these is firm and which is probable, because a Atlanta patient promised mood improvement and not getting it has been misled.
