Hormone replacement therapy (HRT) – your questions answered

General Practitioner at Bupa UK
17 November 2020

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

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 quality of life.

HRT also has some 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. It’s possible that HRT may also help to improve your muscle mass and strength over the long term. HRT may also reduce risk of cardiovascular disease in women who start taking it 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 the majority of women under 60 years of age, the benefits of HRT outweigh the risks. In some women, 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.

  • Taking combined HRT (with oestrogen and progestogen) for more than a year increases your risk of developing breast cancer. For every 100 women that use HRT for five years, there are about two extra cases of breast cancer. An estimated eight in 100 women who take HRT for five years will develop breast cancer, compared to six in 100 people who never take it.
  • The longer you take it, the bigger the risk. 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 combined HRT is also associated with a small increase in risk of ovarian cancer. This increased risk disappears within a few years of stopping treatment.
  • Long-term use of oestrogen-only HRT is associated with an increased risk of endometrial cancer (a type of cancer of the womb).

Don’t forget, lots of other things can affect your risk of these cancers. For instance, being overweight or obese, drinking alcohol and not doing enough exercise can also have a significant effect on 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 necessary your doctor may prescribe HRT patches or gel applied to the skin rather than tablets, as these are associated with less 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 from woman to woman. Some women take it for a few years while they’re experiencing the worst of their symptoms, and then come off it. Others continue to take it for much longer if they’re still getting benefits from it. Your doctor will want to review your treatment regularly to see how you’re getting on. They can also help you decide how long you should keep taking it for.

How can I decide whether to take HRT?

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

If you’re struggling with menopause symptoms, or want to support someone who is, we’re here to help. There’s lots of information, expert advice and signposting on the menopause pages within our Women’s Health Hub, and you don’t need to be a Bupa customer to access any of it.

Dr Samantha Wild
General Practitioner at Bupa UK

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    • Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping. Medicines and Healthcare products Regulatory Agency (MHRA)., published 30 August 2019
    • Menopause. NICE Clinical Knowledge Summaries., last revised March 2017
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