Doctor's Library

HRT: What Is It and Who Might Benefit?

Hormone replacement therapy (HRT) is one of the treatments available for symptoms associated with menopause and perimenopause. For many women, it can make a meaningful difference to symptoms and quality of life.

Deciding whether HRT is right for you is an individual decision. It depends on your symptoms, medical history, personal circumstances and your own preferences.

What is HRT?

HRT replaces hormones that the body gradually produces less of during menopause. Depending on your circumstances, treatment may involve oestrogen, progesterone or both.

If you have a uterus, oestrogen is usually prescribed alongside a progestogen to protect the lining of the womb. If you have had a hysterectomy, you may be able to use oestrogen alone, although this depends on your individual medical history.

What symptoms can HRT help?

HRT can be used to treat a range of menopausal symptoms. These can include:

HRT can also help prevent bone loss and reduce the risk of fractures associated with osteoporosis in appropriate women.

Who might benefit from HRT?

HRT may be considered for women experiencing troublesome menopausal symptoms when the potential benefits are likely to outweigh the risks.

It can be particularly helpful when symptoms are affecting sleep, work, relationships, confidence or everyday quality of life.

HRT may also be recommended for women who experience menopause earlier than expected, including premature ovarian insufficiency, where treatment is often advised unless there is a medical reason not to use it.

Your age, medical history, family history, symptoms and individual circumstances are all important when considering treatment.

Is HRT safe?

For many women, HRT can be an effective treatment for troublesome menopausal symptoms and can make a meaningful difference to quality of life.

The balance of benefits and risks is individual. Your age, when you started menopause, your medical history, family history, type of HRT and route of administration can all influence what may be appropriate for you.

HRT is not risk-free, but neither is leaving significant menopausal symptoms untreated. The important question is how the potential risks compare with the benefits for you.

Current guidance recommends discussing the benefits and risks of HRT so that women can make informed decisions about their treatment. Overall, for people aged 45 and over, HRT is unlikely to affect life expectancy.

Does HRT increase the risk of breast cancer?

The relationship between HRT and breast cancer risk is complex and depends on several factors, including the type of HRT used and how long it is taken.

Combined HRT containing oestrogen and a progestogen is associated with a small increase in breast cancer risk, and the risk generally increases with duration of use. The absolute increase in risk is small for many women, but it is important to discuss your individual circumstances.

Oestrogen-only HRT has a different risk profile and may have little or no increase in breast cancer risk for some women.

A consultation allows these factors to be considered alongside your personal and family history.

Are there different types of HRT?

HRT is available in different forms and routes of administration.

Oestrogen can be given as:

Progestogen can be provided in several ways, including tablets or through a hormonal intrauterine system in appropriate women.

The route of treatment can be important. For some women, transdermal oestrogen may be preferable to tablets because it does not increase the risk of blood clots in the same way that oral oestrogen does.

How long can you take HRT?

There is no arbitrary maximum duration for HRT.

Some women need treatment for several years, while others may choose to stop earlier. The decision should be reviewed periodically and based on your symptoms, health and individual balance of benefits and risks.

You do not need to stop HRT simply because you have reached a particular age. Ongoing treatment can be considered when the benefits continue to outweigh the risks.

What about "bioidentical" HRT?

The term "bioidentical" can be confusing because it is used to describe different types of treatment.

Some regulated HRT products contain hormones that are chemically identical or very similar to hormones produced naturally by the body. These are different from unregulated compounded preparations, which may not have the same evidence, quality control or safety monitoring as licensed medicines.

If you are considering HRT, it is important to understand exactly which treatment is being recommended and why.

At VERA MD

At VERA MD, we believe HRT decisions should be based on careful assessment, clear information and shared decision-making.

There is no single HRT prescription that is right for every woman. Our aim is to understand your symptoms, medical history and priorities before discussing the options that may be appropriate for you.

HRT is not about treating a number on a blood test. It is about treating the woman in front of us.

If you are considering HRT, already taking HRT, or simply unsure whether it may be appropriate for you, a menopause consultation can be a useful place to start.

This article is intended for general information and does not replace individual medical advice. If you have concerns about your symptoms or health, please speak with an appropriately qualified healthcare professional.