HRT: the facts, the benefits and the risks

What HRT is

HRT replaces the hormones that fall during menopause, mainly oestrogen. If you still have a womb, you also need a progestogen to protect the womb lining. If you have had a hysterectomy, oestrogen alone is usually enough.

The different types

• Oestrogen can be a gel, spray, patch or tablet. Gels, sprays and patches go through the skin (transdermal).
• Progestogen can be a tablet or the hormonal coil, which also works as contraception.
• Combined products contain both, as a patch or tablet.
• Vaginal oestrogen treats vaginal and bladder symptoms locally, with very little reaching the rest of the body.

Body-identical hormones have the same structure as the hormones your body makes. Licensed, regulated body-identical HRT is widely prescribed and recommended by the British Menopause Society. Compounded “bioidentical” hormones made up by some private clinics are not regulated and are not recommended. We prescribe licensed treatments only.

Benefits

• Relief of hot flushes, night sweats and many other symptoms
• Protection against bone thinning (osteoporosis) and fractures
• Improvement in vaginal and bladder symptoms
• For many people, better sleep, mood and quality of life

Risks, explained honestly

Breast cancer. HRT with oestrogen and progestogen is linked to a small increase in breast cancer risk, which depends on the type and how long it is taken, and falls after stopping. Oestrogen-only HRT has little or no increase. For context, the extra risk is similar to or lower than the risk linked to drinking alcohol or being overweight.

Blood clots. HRT tablets slightly increase the risk of clots. Oestrogen through the skin (gel, spray or patch) does not increase the risk at standard doses.

Stroke. Tablets may slightly increase stroke risk; transdermal oestrogen at standard doses does not appear to.

Your own balance of benefits and risks depends on your age, health and family history. That is what we work through with you in a consultation.

Who may not be suitable

HRT may not be right if you have had certain cancers, such as breast cancer, or have untreated high blood pressure, active liver disease or unexplained bleeding. Even then, there are often other options. If your history is complicated, a complex consultation gives the extra time needed.

Starting HRT

Side effects such as breast tenderness, bloating or irregular bleeding are common in the first few months and often settle. That is why we review you at around three months.

How long can I take it?

There is no set time limit. Many people take HRT for years. We review the benefits and risks with you every year so the decision stays yours.

Testosterone

If HRT alone hasn’t helped low sexual desire, NICE guidance supports considering testosterone. In the UK it is prescribed “off-label” for women, which we explain fully. We can assess whether it may be suitable for you.