This prospective cohort study used UK Biobank data to assess whether menopausal hormone therapy (MHT) — by current use, past use, duration, and time since cessation — is associated with incident benign paroxysmal positional vertigo (BPPV) in 157,245 postmenopausal women (2,627 events), using cause-specific Cox regression adjusted for sociodemographic, lifestyle, cardiometabolic, and comorbidity factors.
Both current (HR 1.22, 95% CI 1.09–1.38) and past (HR 1.28, 95% CI 1.17–1.39) MHT use were associated with higher BPPV risk vs. never use; risk rose with duration (HR 1.50 at ≥10 years; p-trend <0.001), persisted ≥10 years after stopping (HR 1.39), and was stronger for recurrent than single-episode disease (HR 1.83 vs. 1.41 at ≥10 years).
- BPPV ascertainment relied on hospital ICD-10 codes and primary-care records, likely undercounting milder cases. - MHT status, duration, and time since cessation were self-reported, introducing misclassification risk. - Exploratory formulation and bone-mineral density analyses were inconclusive, leaving the biological mechanism unresolved.
These findings are hypothesis-generating and should not prompt changes to individual MHT prescribing decisions. Clinicians may note the positive association as context when counselling postmenopausal women about BPPV risk, pending prospective validation.
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