What do we currently know about the health risks and benefits of hormo​​ne replacement therapy?

There has been debate for decades regarding hormone replacement therapy and its associated health effects, risks, and side effects. In 2002, a study by the Women's Health Initiative (WHI) raised concerns and caused widespread confusion.

The study suggested that HRT could have negative health consequences, such as an increased risk of breast cancer. This led to negative media coverage and a period of scepticism surrounding hormone treatments.

However, more recent research paints a different picture. There is now growing evidence to suggest that the risks are not as severe as the WHI study initially indicated. Current studies show that HRT is a safe and effective treatment for most women experiencing menopausal symptoms. In fact, it may even provide various health benefits. In fact, recent studies indicate that women who commence hormone replacement therapy at the appropriate time (before the age of 60) and continue it for several years during menopause generally experience longer and healthier lives on average. Hormone replacement therapy seems to lower the risk of cardiovascular diseases, dementia, osteoporosis, and overall mortality. These beneficial effects are especially evident in women who initiate therapy around the onset of menopause.

Experts regard HRT as the most effective treatment for menopausal symptoms.

Additionally, the medication has become much more advanced and refined. Doctors and researchers agree that HRT can be used safely and effectively by most women, particularly if started early.

Leading organisations, such as The Menopause Society, recommend the treatment as the best option for vasomotor symptoms, such as hot flushes, during menopause. After a few days, the initial minor symptoms may begin to subside. Read here to discover what else you can expect from hormone replacement therapy.

As with any medication, there are risks associated with hormone replacement therapy (HRT). These risks are particularly pertinent for women who begin treatment later in menopause, use it for an extended duration (often exceeding five years), and depend on factors such as the specific product, dosage, method of administration, and individual medical history.

Oral hormone replacement therapy with oestrogen slightly increases the risk of thrombosis, stroke, and gallbladder problems. When administered through the skin, the risk of thrombosis is lower; however, gallbladder problems may still occur. If you have a uterus, progesterone/progestogen is always required alongside oestrogen to prevent uterine cancer. Combined hormone replacement therapy carries a rare but increased risk of breast cancer when used long-term. Hormone replacement therapy applied vaginally is minimally absorbed and does not show an increased risk of these conditions.  

For some women, hormone replacement therapy may not be the most suitable option, particularly in cases of (a history of) breast cancer, hormonal cancer, thrombosis, liver disease, stroke, or abnormal vaginal bleeding.