Over the last few years Hormone replacement therapy has not always got the best press. This article explores the pros and cons of HRT, to help you make an informed choice about whether it might be right for you as you transition into reach menopause. Some authorities consider that the menopause is a hormone deficiency that always needs treatment. These articles are intended to help you make informed decisions about your care, to help you stay in control of your health and healthcare.
How does HRT work?
HRT helps to relieve symptoms of menopause by replacing oestrogen levels that naturally fall in menopause. You can take HRT as tablets or through a patch or gel on your skin.
If HRT is suitable for you and you are interested in taking it, your GP should discuss the benefits and risks with you, both in the short term (the next 5 years) and in the future, before you decide to start it.
Benefits of HRT
As well as alleviating more immediate and “obvious” symptoms like hot flushes and low sex drive, there are other benefits to HRT.
Improving muscle strength
You may lose muscle strength as you reach menopause, and HRT may improve this. However, it is also important to carry on with daily activities and exercise, which will help you to stay as strong and fit as possible.
Preventing osteoporosis
Studies show that HRT can prevent the bones from getting thinner and may even improve bone density if there has already been some reduction. Your GP should explain that for women around menopausal age the risk of breaking a bone is low because the bone density at this age is often normal. HRT prevents bone loss while you are taking but will resume when you stop HRT. The longer you have been taking HRT the greater the protection from osteoporosis in the later life
Protecting your heart and blood vessels
There appears to be a protective effect on heart disease for those women who take HRT below 60 years.
Mood swings
Research shows that HRT may be able to help with mood swings.
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Risks of HRT
There are some risks with HRT summarised below, although more research is emerging all the time. NICE have analysed the latest studies to understand these risks better and you can also read about the risks and benefits on the NHS information pages about HRT. Your GP should explain that any conditions that may be caused by HRT will vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.
Blood clots
HRT tablets (but not patches or gels) are linked with a higher risk of developing a blood clot. If you are already at higher risk of blood clots (for example, you are obese) and you are considering HRT, you may be offered patches or gel rather than tablets. If you have a strong family history of blood clots or if there’s another reason why you are at high risk of blood clots, you may be referred to a haematologist (a doctor who specialises in blood conditions) before considering HRT.
Heart disease and stroke (cardiovascular disease)
- If you start HRT before you’re 60 it does not increase your risk of cardiovascular disease.
- HRT does not affect your risk of dying from cardiovascular disease.
- HRT tablets (but not patches or gels) slightly raise the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.
If you’re already at higher risk of cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your GP can give you more information.
Breast cancer
There has been some confusing and sometimes contradictory information about HRT and breast cancer over the years. However, studies show that for women around menopausal age:
- Oestrogen‑only HRT causes little or no change in the risk of breast cancer.
- HRT that contains oestrogen and progestogen may increase breast cancer risk. This risk may be higher if you take HRT for longer but falls again when you stop taking HRT.
- For context there are around 23 cases of breast cancer in every 1000 women in the UK. Studies have shown that this rises to 27 for women on combined HRT. This useful infographic from Women’s health concern may help to you to better understand a range of lifestyle risk factors for breast cancer, versus HRT. For example, there is evidence that regular exercise can help reduce the risk of breast cancer.
HRT needs to be considered carefully for women with, or at high risk of, breast cancer, for example because of a family history of breast cancer.
Type 2 diabetes
According to NICE, HRT does not increase your risk of developing type 2 diabetes. If you already have type 2 diabetes, HRT is unlikely to have a negative effect on your blood sugar control. When deciding if HRT is suitable for you, your GP should take into account any health problems related to your diabetes and may ask a specialist for advice before offering you HRT.
Dementia
Some studies suggest that HRT, particularly oestrogen only, may reduce the risk of Dementia. However this is not yet conclusive.
When to stop and start HRT
Your GP should tell you what to expect when you start taking HRT. It’s common to have some unscheduled vaginal bleeding in the first 3 months of taking HRT, for women who have a womb. If it happens after the first 3 months tell your GP straightaway.
Remember! HRT is not a not a contraceptive. You need to keep using contraception of some kind until some 6 months after your periods have stopped.
Some specialists consider the menopause to be a permanent hormone deficiency which requires lifelong treatment for those who can take it. If you are thinking about stopping HRT, you can either stop immediately or gradually reduce your dose. You may have some menopausal symptoms again after stopping HRT, although they may return less quickly if you stop gradually. Your GP should give you more advice about this.
There’s no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment. Most women stop taking it once their menopausal symptoms pass, which is usually after a few years. Contact your GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.
Our articles linked are intended to help you make informed decisions about your care, to help you stay in control of your health and healthcare
Read more Evergreen Life articles on menopause:
Menopause: Treatment and Support
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Reviewed by:
Dr Brian Fisher MBBCh MBE MSc FRSA Medical Expert
Dr James Harmsworth King MBBS MPhil PhD Biotechnology & Medical Expert
Overview | Menopause: diagnosis and management | Guidance | NICE
