Meta-analysis of existing studies found menopausal hormone therapy (MHT) neither increases nor decreases dementia risk in postmenopausal women, contradicting both optimistic and pessimistic claims about cognitive protection. The neutral finding emerges from pooled data across multiple trials and observational studies, though researchers noted significant heterogeneity in formulations, dosing, and timing protocols examined. This evidence challenges the "critical window" hypothesis that early hormone intervention might preserve cognitive function, while also refuting concerns that estrogen supplementation accelerates neurodegeneration. The lack of clear benefit or harm suggests the relationship between reproductive hormones and brain aging is more complex than binary models predict. For clinicians, this reinforces that MHT decisions should prioritize established benefits like vasomotor symptom relief and bone health rather than speculative neuroprotection. The finding is particularly relevant given that roughly 13% of postmenopausal women use hormone therapy, often motivated partly by cognitive concerns. However, the review highlights critical research gaps around optimal timing, specific populations like women with premature menopause, and whether certain formulations might show differential effects that current broad analyses miss.