Despite landmark randomised trials and systematic reviews  declaring that MHT does not provide any protective effects from cardiac events or mortality, this has been challenged by more recent studies examining both clinical end-points and surrogate markers of atherosclerosis progression. What is clear is that there remains significant confusion regarding MHT’s benefit, or lack thereof, in relation to cardiovascular health. Discouragingly, it has been noted that it is “unlikely” that additional large, prospective trials will be performed investigating MHT’s impact on cardiovascular disease due to existing controversy, fear of potential harm and the expense associated with longitudinal follow-up . We hope that our utilisation of biomarkers provided by CMR in the context of a large-scale, population-based study such as UK Biobank has provided a useful and novel method of examining MHT’s influence on the cardiovascular system.