Hormone replacement therapy: the benefits and risks of HRT

Weighing up the benefits and risks of HRT? Understanding the pros and cons can help you decide if hormone replacement therapy is right for you

Hormone replacement therapy is the first-line treatment recommended by NICE for the treatment of perimenopause and menopause symptoms. It is currently taken by 2.6 million women in England [1].

Most women (80%) experience symptoms [2], although symptoms themselves vary between women and you can experience a range of symptoms, which can change with time. Just as symptoms can vary between women, so too can the dose and type of HRT prescribed. There is no one standard HRT treatment – don’t be surprised if your friends’ prescription varies from your own.

HRT can contain hormones oestradiol (oestrogen), progesterone and testosterone. They are prescribed separately, and you may find that your dose and type of each may need tweaking during your perimenopause and menopause, to optimise your body’s response to symptoms.

If you want to find out if HRT is right for you or if you need to make an adjustment to your dose or type, book an appointment to speak to a Newson Clinic healthcare professional here.

What are the benefits of HRT?

HRT can improve the symptoms of perimenopause and menopause. For most women, the benefits of HRT outweigh any risks (these depend on your individual medical history and age).

HRT is an effective treatment across a range of symptoms – it usually very quickly stops hot flushes and night sweats, for instance. Other symptoms such as hormonal low mood and energy, brain fog, vaginal and urinary symptoms such as vaginal dryness and UTIs, muscle and joint pains, lack of libido, headaches, hair and skin changes, changes to periods, anxiety, irritability and heart palpitations usually resolve or improve.

Some of the symptoms of perimenopause and menopause may take a little time to resolve so it is worth giving HRT enough time to work – you should see improvements within three months.

HRT also benefits your future health and reduces future risk of diseases. Lower levels of hormones are associated with an increased risk of developing health conditions including osteoporosis (bone weakening), cardiovascular disease, type 2 diabetes, dementia and cognitive decline, auto-immune diseases and some cancers. HRT replaces the hormones your body is missing, so reduces these risks. For instance, taking HRT can help prevent and repair bone loss, and it can lower your risk of developing heart disease [3]. It can also lower your risk of developing type 2 diabetes and bowel cancer [4].

What are the risks of HRT?

The risks of HRT will be individual to you – and will depend on your age, your medical history and your family’s medical history, as well as the type of HRT you are given.

For instance, synthetic oestrogen tablets are associated with a small increased risk of clot or stroke. However, body identical oestrogen patches, gel and spray are not associated with this risk.

The risk that has gained the most headlines over the years concerns breast cancer. Combined synthetic HRT (oestrogen and progestogen) may be associated with a small risk of developing breast cancer [5]. However, this risk has not been shown to be statistically significant [6].

The risk of breast cancer is reduced if micronised progesterone is used [7]. It is worth keeping the risk of breast cancer in perspective – it is greater in women who are overweight, do not exercise, drink moderate amounts of alcohol compared to in those women taking any types of HRT [8].

References

1. NHSBSA:  HRT England April 2015 to June 2024
2. Woods N.F., Mitchell E.S. (2005), ‘Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women’s lives’, Am J Med. 118 Suppl 12B:14-24. Doi: 10.1016/j.amjmed.2005.09.031
3. Hamoda H., Panay N., Pedder H., Arya R., Savvas M. (2020), ‘The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women’, Post Reproductive Health. 26(4) pp181-209. doi:10.1177/2053369120957514
4. Langer, R. D. (2021), ‘The role of medications in successful aging’, Climacteric, 24(5), pp505–512. https://doi.org/10.1080/13697137.2021.1911991
5. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. (2002), ‘Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial’, JAMA, 288(3):321-33 10.1001/jama.288.3.321
6. Bluming A.Z., Hodis H.N., Langer R.D. (2023), ‘’Tis but a scratch: a critical review of the Women’s Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer’, Menopause. 30(12) pp1241-1245. doi: 10.1097/GME.0000000000002267
7. Asi N., Mohammed K., Haydour Q., Gionfriddo M.R., Vargas O.L., Prokop L.J., Faubion S.S., Murad M.H. (2016), ‘Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis’, Syst Rev. 5(1):121. Doi: 10.1186/s13643-016-0294-5
8. Dydjow-Bendek DA, Zagożdżon P. (2021), ‘Early Alcohol Use Initiation, Obesity, Not Breastfeeding, and Residence in a Rural Area as Risk Factors for Breast Cancer: A Case-Control Study’, Cancers (Basel), 13(16):3925. doi: 10.3390/cancers13163925