Hormone replacement therapy (HRT) is an effective method of treating menopause symptoms and restoring women’s quality of life as the hormones fluctuate. Although it can successfully alleviate symptoms for most women, certain risks and side effects of HRT mean it is not suitable for all women.
That said, updated research suggests the benefits of HRT are far greater than the risks for the majority of women. This article explains the possible risks and side effects of HRT, how they can be reduced, and when HRT should be avoided.
Why Is HRT Prescribed for Perimenopause and Menopause?
During perimenopause, HRT is primarily prescribed to balance the female hormones estrogen and progesterone. Some women also require testosterone.
By re-balancing fluctuating hormones, symptoms such as hot flashes, anxiety, mood swings, vaginal dryness, fatigue, and low libido are alleviated, allowing women to enjoy a steady quality of life as they transition into menopause.
Due to the minimal levels of estrogen produced once women enter menopause, symptoms such as vaginal dryness, hot flashes, and low libido can continue to occur for many, but not for others.
Low estrogen levels in menopause can also cause decreased bone density which can result in the onset of osteoporosis and increased bone fractures as women age.
Modern studies have shown that osteoporosis and other menopause symptoms can be minimized and often prevented by supplementing with HRT.
Are there Different Types of HRT?
Yes. Hormone fluctuations occur differently in each woman and to accommodate the various individual needs, HRT is available in several types, doses, and combinations. Hormone therapy is also produced by several brands and can be taken in different ways.
Systemic HRT
Systemic HRT is when hormones are administered via the bloodstream in the form of pills or shots, or by applying transdermal gels, patches, or vaginal rings. Systemic HRT may be estrogen-only for some women and combined HRT for others (estrogen and progesterone).
Combined HRT
Combined HRT can also be taken as a continuous form of HRT, or as cyclic HRT, where progesterone is cycled for only half of the month according to a woman’s needs.
Local HRT
Local HRT, on the other hand, is used to treat symptoms affecting the genitourinary system which includes the vagina, vulva, bladder, and urethra. Local HRT can treat symptoms such as vaginal dryness or irritation, pain with sex, urinary frequency and urgency, and recurrent urinary tract infections. It typically comes as a cream, gel, ring, or suppository.
What Are the Risks of HRT?
A 2002 study called the Women’s Health Initiative (WHI) suggested that HRT could increase the risk of breast cancer, strokes, and blood clots in all women, which put many women off the idea of using HRT for relieving menopause symptoms.
Since then, updated and more specific research has concluded that the risks of HRT are minimal for the majority of women when the type of HRT is considered along with a woman’s age and overall health. Based on these findings, evaluating each woman’s overall health and medical history is advised to determine if HRT is the right solution for them.
Breast Cancer and HRT
Since the 2002 study, one of the biggest concerns women have about taking HRT is the risk of breast cancer. In this regard, updated research shows that the increased risk from taking HRT is so small it can be compared to the risk of consuming 1-2 glasses of wine every evening. Interestingly, the very small risk of developing breast cancer is not due to estrogen but is associated with progestin (the synthetic form of progesterone). Progestins are linked with an excess risk of 1 woman developing breast cancer per 1000.
Research has confirmed that the risk of developing breast cancer is actually decreased for women who have had a hysterectomy when taking estrogen-only HRT.
Women who have had breast cancer are advised to speak with their healthcare provider about the differences between taking systemic hormone therapy and local HRT to treat their menopause symptoms. There are also a variety of nonhormonal options available to reduce bothersome symptoms.
As for all women, those taking HRT are advised to attend regular check-ups and mammograms to monitor any changes.
Blood Clots, Strokes, and HRT
Taking systemic HRT by mouth, which affects the entire body, is known to slightly increase the risk of developing venous blood clots, strokes, or clots in the lungs.
However, additional research has shown that the likelihood of women experiencing blood clots or strokes whilst taking HRT largely depends on the route of administration, underlying conditions, and other risk factors. Vaginal estrogen, or systemic estrogen taken via patch, gel or ring does not increase the risk of developing blood clots or stroke.
Other risk factors can include being a smoker, overweight or obese. Having a history of high blood pressure, clotting disorder, high cholesterol, atrial fibrillation, or strokes are also considered added hazards.
Does HRT Cause Side Effects?
Some women are known to experience side effects when they first start taking HRT, the most common of which include breast tenderness, vaginal bleeding, and bloating. HRT patches applied to the skin can also cause a skin reaction or irritation in some women.
Although these side effects are not typically categorized as serious, they can temporarily alter women’s quality of life. Research shows, however, that these side effects usually resolve with time as the body adjusts to the supplemented hormones. Vaginal bleeding in postmenopausal women is always considered abnormal, however, it is not uncommon to see when initially starting HRT or changing dosing.
If side effects do not subside, it’s wise to speak with your healthcare provider about changing the route or dose of HRT.
Can HRT Be Taken Long Term?
Outdated medical research into hormone therapy for menopause suggested that taking the lowest dose of HRT for the shortest possible time is safest. This can be true for certain women under particular circumstances, however, it is not true for all women.
Women who experience lasting menopause symptoms can safely take HRT long-term under the supervision of their healthcare provider. Moreover, taking HRT is known to reduce the risk of developing osteoporosis in older age.
In the absence of any heightened risks, women can safely take HRT for the rest of their lives.
Conclusion
HRT is a safe and efficient way of treating menopause symptoms for the majority of women and it can prevent the onset of osteoporosis. Even though certain underlying health conditions and risk factors can deem HRT unsuitable for some, a thorough evaluation with a healthcare provider can quickly determine if it’s right for you.
If you’re seeking to ease perimenopause or menopause symptoms, schedule an appointment with your healthcare provider to understand the updated research on HRT and how best to decrease exposure to risks or side effects.
References
Cleveland Clinic – Perimenopause - https://my.clevelandclinic.org/health/diseases/21608-perimenopause
Mayo Clinic - Menopause: Symptoms and Causes - https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
Cleveland Clinic – Postmenopause - https://my.clevelandclinic.org/health/diseases/21837-postmenopause
National Library of Medicine - Estrogen therapy for osteoporosis in the modern era - https://pubmed.ncbi.nlm.nih.gov/29520604/
National Library of Medicine - Menopausal Hormone Therapy Trends Before Versus After 2002: Impact of the Women’s Health Initiative Study Results - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538484/
BreastCancer.org – Using HRT - https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy
Balance Menopause – Understanding the Risks of HRT - https://balance-menopause.com/uploads/2023/10/Risks-of-HRT-visual-aid.pdf