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Hormone replacement therapy for menopause: benefits, risks and options
How hormone replacement therapy works, its benefits and risks, who usually can't take it, non-hormonal menopause treatment, and what to ask your doctor.
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Hormone replacement therapy for menopause: benefits, risks and options
Hormone replacement therapy (HRT), also called menopausal hormone therapy, replaces the estrogen your body makes less of around menopause. It's the most effective treatment for hot flashes and night sweats, and it also helps vaginal dryness and protects bones. It carries some risks, such as blood clots, stroke and breast cancer, which depend on your age, health and the type you use.
Written by the Gyne team · Medical review: pending
Key takeaways
- HRT is the most effective treatment for hot flashes and night sweats.
- For many people under 60, or within 10 years of menopause, the benefits are likely to outweigh the risks.
- Risks depend on your age, health history and the type of HRT, such as tablets or patches.
- Vaginal estrogen for dryness uses a very low dose and carries much lower risks.
- Non-hormonal treatments exist if you can't or don't want to use hormones.
What is hormone replacement therapy?
Around menopause, your ovaries make less estrogen, which can cause hot flashes, night sweats, sleep problems and vaginal dryness. HRT tops up estrogen to ease these symptoms.
If you still have a uterus (womb), estrogen is usually combined with a progestogen, a progesterone-like hormone, because estrogen on its own can raise the risk of cancer of the uterus lining. If you've had a hysterectomy, estrogen alone is usually used.
What types of HRT are there?
HRT comes in several forms. Your doctor will talk with you about which suits your symptoms and health:
- Systemic estrogen, which reaches the whole body, as tablets, skin patches, gels or sprays.
- Progestogen, as tablets, combined patches or a hormonal IUD (intrauterine device).
- Local vaginal estrogen, as a cream, tablet, insert or ring, for dryness and pain during sex.
- Testosterone, which some specialists prescribe for low sex drive.
What are the benefits of HRT?
The main benefit is relief from menopause symptoms. Many people notice a difference within a few days or weeks.
- Fewer and milder hot flashes and night sweats.
- Better sleep when night sweats were waking you.
- Help with low mood and anxiety caused by menopause.
- Relief from vaginal dryness and pain during sex.
- Less bone loss, which lowers the risk of osteoporosis and fractures.
- Help keeping muscle strength.
What are the risks of HRT?
The risks of serious side effects are low for most people, and they depend on the type of HRT, how long you use it and your own health.
Combined HRT slightly raises the risk of breast cancer. The NHS estimates about 5 extra cases for every 1,000 women who take combined HRT for 5 years, and the risk falls again after stopping. Estrogen-only HRT has little or no increase.
HRT tablets can raise the risk of blood clots and stroke, though the risk is still low, especially under 60. Patches, gels and sprays through the skin do not seem to raise the risk of clots. Common side effects include breast soreness, bloating and spotting, which often settle within a few months.
Is HRT safe?
Fears about HRT grew after a large US study in 2002. Later research found that most of the harm was in women over 60 who started HRT years after menopause, and that younger women have lower risks and more benefits.
Today, for many people under 60, or within 10 years of their last period, who aren't at high risk of breast cancer or blood clots, the benefits are likely to outweigh the risks. Whether it's right for you is a decision to make with your doctor, based on your symptoms and history.
Who usually can't take HRT?
Systemic HRT usually isn't recommended if you've ever had breast or uterine cancer, a stroke, a heart attack, blood clots or liver disease. It's also not for use in pregnancy.
Even then, other treatments may help, and vaginal estrogen is sometimes still an option. Ask your doctor what's possible for you.
What are non-hormonal menopause treatments?
If you can't take HRT, or don't want to, there are other options to ask your doctor about:
- Some antidepressants at low doses, for hot flashes and mood.
- Gabapentin or clonidine, which can reduce hot flashes and help sleep.
- Fezolinetant, a newer medicine that targets the brain's temperature control.
- Over-the-counter vaginal moisturizers and lubricants for dryness.
- Lifestyle steps, like keeping cool, dressing in layers and limiting alcohol and caffeine.
What should I ask my doctor about HRT?
Bring a list of your symptoms and how much they affect you, plus your personal and family history of cancer, clots, stroke and heart disease. Useful questions include:
- Which type and form would suit me, and why?
- What are my personal benefits and risks?
- How will we know if it's working, and when will we review it?
- What non-hormonal options could I try instead?
When to see a doctor
- Menopause symptoms affect your sleep, work, relationships or mood.
- Your periods stop or symptoms start before age 45.
- You use HRT and have unexpected bleeding, or bleeding that continues after the first 6 months.
- You have any bleeding after 12 months without a period and you don't use HRT.
- You notice a breast lump or a change in your breasts.
- You have chest pain, sudden weakness on one side, trouble speaking, or a painful, swollen leg with shortness of breath: call 911 or your local emergency number.
How Gyne helps
Gyne tracks hot flashes, night sweats, sleep, mood and other symptoms, includes a menopause rating scale to see how they change over time, and builds an editable report to help you start a treatment conversation with your doctor. It never recommends a treatment.
Perimenopause and menopauseThis guide is general information, not medical advice. Only a doctor can diagnose a condition.