This study used a large population-based cohort, with uniform assessment of exposures, covariates and outcomes. Importantly, there was no difference in socioeconomic status between the two groups; previous studies have highlighted that women prescribed MHT are of higher social class and educational attainment–and therefore, in general, healthier–than women who do not receive MHT, thereby confounding results . This is something that we have attempted to control for in this data. However, there are several limitations that should be considered in the interpretation of the findings. Firstly, the analysis was cross-sectional, thus causality cannot be inferred from the associations demonstrated. Secondly, it was not possible to explore longitudinal change in cardiac structure in relation to MHT use. Thirdly, all menopause and MHT data was self-reported. Finally, we were not able to provide data on type of MHT due to significant amount of missing data.