Hormonal replacement therapy (HRT) is a treatment that works by replacing hormones that fall naturally during menopause. HRT is the most effective treatment option available to improve your menopause symptoms, as well as potentially carrying some other additional benefits in terms of health conditions. 

What is HRT? 

HRT is a treatment that works by replacing the hormones that fall naturally during menopause. It can consist of the hormones: 

Oestrogen: Body-identical or natural oestrogens are used - mostly they are processed from yam or soya beans but sometimes, conjugated equine oestrogens are used. They can be delivered by tablet, patch, gel or implant. 

Progesterone: Body-identical or natural progesterone is used - generally made from plants or derived from testosterone. They can be delivered by an intrauterine system [IUS], tablets, patches, or vaginal pessaries. 

Testosterone: Generally delivered through the skin via a gel. 

There are a few different types, regimes, and ways of taking HRT - which type depends on the individual (i.e., your experience of symptoms and medical history). HRT should always be prescribed by a doctor/GP according to your individual medical history, symptoms, age, personal preference, etc. 

Important to note: If you’ve had a hysterectomy, you can use oestrogen-only HRT, but if you have a womb, the progesterone component is needed. This is to prevent oestrogen from stimulating the lining of the womb and increasing the risk of womb cancer. 

What are the potential risks & benefits of HRT? 

This is a question most women want to know the answer to – is HRT safe? For most women HRT is safe, but it depends largely on the individual. The general rules are[1]: 

  • Women under the age of 50: No risks associated with HRT at this age because it replaces normal hormones at that age. 

  • Women under the age of 60: The benefits generally outweigh the risks. 

  • Women under the age of 70: The benefits are approximately equal to the risks. 

  • Women 70+: The risks of HRT start to outweigh the benefits. 

 

Potential risk  Potential benefit 
Small increased risk of breast cancer (not in first five years)  Reduction in menopausal symptoms (improved quality of life) 
Increased risk of endometrial cancer with oestrogen-only HRT  Protection against osteoporosis and risk of fracture (and osteoarthritis) 
Combined HRT taken orally slightly increases risk of stroke  Decrease in CV disease if started within 10 years of menopause/under 60 
Increased risk of blood clots in the legs/lungs with oral HRT  Improvements in muscle mass/strength (and sarcopenia) 


Reminder: HRT remains the most effective solution for menopausal symptoms and carries some other benefits BUT it is not completely risk-free and will not be suitable for everyone. Ultimately, you need to discuss this with your doctor/GP. 

References

[1]Rees, M., Abernethy, K., Bachmann, G., Bretz, S., Ceausu, I., Durmusoglu, F., ... & Lambrinoudaki, I. (2022). The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas, 158, 70-77.