Hormone replacement therapy (HRT) – your questions answered

Samantha Wild
Clinical Lead for Women's Health and Bupa GP
14 November 2023
Next review due November 2026

If you’re experiencing symptoms of menopause, you may be considering taking hormone replacement therapy (HRT). Here, I answer some of the most commonly asked questions about HRT.

woman looking pensively out of the window

What does HRT do?

Hormone replacement therapy (HRT) tops up or replaces low levels of a hormone called oestrogen, which naturally decreases with age. It's the fluctuation in hormones and eventual reduction in oestrogen levels that can cause menopause symptoms.

HRT may also include a hormone called progestogen. This is known as combined HRT. If you have a womb (uterus), you should take combined HRT to treat your menopause symptoms.

What are the benefits of HRT?

HRT is effective at easing many symptoms of the menopause, including hot flushes, night sweats, and mood swings. This can really improve your sleep and your quality of life, especially if your symptoms are severe.

HRT may also have long-term benefits. While you’re taking HRT, you have a lower risk of fractures associated with osteoporosis, which is more common after the menopause.

HRT may help to reduce the risk of coronary heart disease. This benefit has been shown in women who start taking HRT before the age of 60, or within 10 years of their menopause starting.

Is HRT safe?

All medical treatments carry a certain amount of risk, and HRT is no different. But for most women younger than 60, the benefits of HRT outweigh the risks.

In some people, the risks may be greater than the benefits. If this is the case, your doctor will discuss this with you.

Can HRT cause cancer?

HRT may increase your risk of developing certain cancers. How much of an effect it will have depends on many things, including the type of HRT you take, when you start taking it, and for how long. Here is a summary of some of the main points to consider.

  • Considering all types of HRT together, taking combined HRT for more than a year increases your risk of developing breast cancer. For every 100 women that take HRT for five years, there are about two extra cases of breast cancer. An estimated 8 in 100 women who take HRT for five years will develop breast cancer, compared to 6 in 100 women who never take it. It’s not known yet whether body identical HRT affects your risk of breast cancer. Body identical HRT is comprised of hormones identical to the ones your body makes.
  • The longer you take HRT, the greater your risk of breast cancer. If you’ve used HRT for more than five years, this increased risk continues for 10 years or more after you stop taking it.
  • There’s little or no increase in breast cancer risk associated with oestrogen-only HRT.
  • Long-term use of HRT is also associated with a small increase in risk of ovarian cancer. This increased risk decreases after stopping treatment.
  • Long-term use of oestrogen-only HRT is associated with an increased risk of endometrial cancer (a type of womb cancer). This is why, if you have a womb, you should take combined HRT to reduce this risk.

Don’t forget, lots of other things can affect your risk of these cancers. For instance, being overweight or obese, smoking, drinking alcohol, and not being physically active enough can also affect your breast cancer risk.

Are there any other risks of HRT?

Both combined and oestrogen-only HRT increase your risk of blood clots in your legs (deep vein thrombosis) if taken by mouth (orally). If necessary, your doctor may prescribe HRT patches or gel applied to the skin rather than tablets, as these don’t have an associated risk.

Combined and oestrogen-only HRT tablets also slightly increase your risk of stroke. Again, your doctor will consider this and may prescribe HRT patches or gel if you have any other risk factors for stroke.

How long can you stay on HRT?

There isn’t a limit for how long you can take HRT. It’ll vary between people - some take it for a few years during the worst of their symptoms, and then stop it. Others might continue to take it for much longer if they’re still getting benefits from it.

Your doctor will want to review your treatment annually to see how you’re getting on, and consider what the safest preparation is for you to take. They can also help you decide how long you should keep taking it for.

Does HRT make you gain weight?

There’s no clear evidence that HRT will make you gain weight, and everybody is different. It’s common to put on some weight during the menopause, so it’s possible that weight gain could be due to the menopause itself.

How can I decide whether to take HRT?

The choice about whether to take HRT is individual to you. Think carefully about the benefits and risks involved. Your GP can help you to assess how these may affect you based on your own circumstances. They can prescribe HRT in the safest, most effective way for you.

If you’re experiencing menopause symptoms, you don’t have to face them alone. With a Bupa Menopause Plan, you can discuss symptoms with a specially trained GP, get a personalised care plan based around your needs with access to 24/7 support via Anytime HealthLine.

Samantha Wild
Dr Samantha Wild
Clinical Lead for Women's Health and Bupa GP



Sheila Pinion, Health Content Editor at Bupa UK

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