HRT

Is HRT safe?

Navigating the menopause can be tough. This is partly because your body starts making less oestrogen - a hormone that plays its part in a range of your body’s functions. If you’re struggling with the symptoms associated with the menopause, hormone replacement therapy (HRT) can help, but is it always safe?

First of all, everyone is unique - so different people might experience different side effects with different treatments. The form of HRT used, the types of hormones it contains and when it’s used for the first time can all influence its effects. Your age and health status can also determine the safest type and form of HRT for you. Your clinician can advise you of which HRT can be most safe for your age and medical history.

Daniel Atkinson

Medically reviewed by

Daniel Atkinson, GP Clinical Lead

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Medically reviewed by

Dr Daniel Atkinson

GP Clinical Lead

on August 02, 2022.

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HRT benefits and risks

There are various types of HRT, such as tablets, gels, patches, pessaries and implants. You can also get oestrogen-only or combined HRT (which has both oestrogen and progesterone in it), which can come as either a cyclical or continuous treatment.

So, due to the range of medication available to menopausal women, there’s likely to always be a form that suits your needs. HRT is only available on prescription, so you’ll need to talk to a clinician before you can make a decision and start your course of treatment.

What are the benefits of HRT?

HRT can help to relieve many menopausal symptoms, like hot flushes, mood swings, vaginal dryness and a reduced sex drive . It can also help to prevent a condition known as osteoporosis (where your bones become weak and brittle). Studies show that this disease becomes more common in post-menopausal women . HRT can also make it easier for women to maintain their weight.

A benefit of using combined HRT is that it can reduce your risk of developing womb cancer , which accounts for around 3% of all cancers diagnosed in women . Depending on your symptoms and your medical history, the benefits of HRT may outweigh the risks. It’s best to talk to a clinician to discuss your options.

Are there risks when using HRT?

The side effects of HRT can vary depending on the type of medication you get prescribed. Even though combined HRT can reduce the risk of womb cancer, it’s also associated with a small increase in the risk of developing breast cancer . Taking HRT for a long amount of time can increase the risk, but these risks start to decrease once you stop taking the treatment. You should speak to your clinician before discontinuing HRT.

The risk of developing blood clots also slightly increases when you take HRT tablets, but evidence shows that there’s no increased risk if you use HRT gels or patches . Heart disease and strokes can also be a concern for those taking HRT tablets, but if HRT is started before 60 years of age, these risks are generally very low . In most cases, the benefits of HRT do outweigh the risks, but this should always be assessed on an individual basis.

Why are there different types of HRT?

Different women have different needs according to their health-history, what stage of the menopause they’re on, and personal preference. Some HRT may simply not be safe for some women, while others will need to be taken alongside other hormones. This means that no matter what your circumstances are, you’ll most likely be able to find a form of HRT that is safe and suitable for you to use.

Is oestrogen-only HRT safe?

Oestrogen-only HRT increases the levels of oestrogen in your body, and it’s safer for some than it is for others. It can increase your risk of womb cancer, for instance , and the longer that it’s used for, the higher the risk.

As a result, oestrogen-only HRT is usually only offered to women who’ve had a hysterectomy – as their risk of developing womb cancer will be non-existent. If it’s prescribed to someone who hasn’t had a hysterectomy then they’ll need to take progesterone alongside it as well. This can be a tablet, gel or a contraceptive ‘coil’ like Mirena or Jaydess.

Is it safe to take combined HRT?

Combined HRT tends to be the safer option for most women. It relieves the symptoms of menopause and reduces your risk of womb cancer. The risks are lower with combined HRT because progesterone stops the endometrial growth caused by too much oestrogen . Even though there are some risks when taking combined HRT, these usually subside after you’ve stopped taking or using it.

What are the differences between continuous and sequential HRT?

Continuous HRT involves taking your medication every day without a break. This applies to combined HRT and oestrogen-only HRT. Sequential HRT, also known as cyclical HRT, is normally recommended for women who are on combined HRT. There are 2 different types of sequential HRT:

Monthly – oestrogen is taken every day, while progesterone is taken alongside it during the last 14 days of your menstrual cycle. Usually recommended for women having regular periods.
3-monthly – oestrogen is taken every day, while progesterone is taken alongside it for 14 days every 3 months. Usually recommended for women having irregular periods.

How long is it safe to stay on HRT?

The length of time it’s safe to stay on HRT will vary between individuals. Your age and health will play a huge part in how long you can safely take it, but there’s ultimately no time limit on how long you can take HRT. Most women can stop taking HRT once their symptoms have stopped. This is usually 2-5 years after they start, but it can be longer for some.

When coming off HRT, you should slowly decrease your doses rather than stop all at once. As you get older, the risks associated with taking HRT increase, especially after 60. Talk with your clinician about how long you should continue to use HRT for.

Is HRT safe for early-onset menopause?

HRT is safe for early-onset menopause, and it could even be beneficial for your health. Some evidence suggests that HRT use in women with early or premature menopause can reduce the risk of cardiovascular disease in the future. It can prevent the development of osteoporosis by maintaining your bone density, and it also takes care of your urinary and vaginal health.

Is it safe to take HRT after age 60?

As you get older, the risks associated with taking HRT increase. Taking HRT after 60 can increase your risk of heart disease, especially if you have hypertension (high blood pressure), due to the stiffening of your arteries as you age. Taking lower doses, in the form of patches or gels, can make HRT safer after 60. Your general health will determine whether or not you should use HRT when you’re over 60.

Are all forms of HRT safe to take?

All forms of HRT are safe to take, but some are safer than others. The suitability of the HRT will depend on who’s taking it. There are five different forms of HRT available:
Tablets
Patches
Gels
Pessaries
Implants
Whilst each form is used to treat the symptoms of the menopause, some forms will benefit some individuals more than others. Before you make your decision, you should discuss the pros and cons of each form with your clinician.

The safety of HRT tablets

Tablets are one of the most common forms of HRT. You only need to take one tablet a day, so they’re a simple and effective method of treatment for menopause. You can get both combined HRT and oestrogen-only HRT in tablet form. Compared to other forms of HRT, the main risk associated with HRT tablets is the higher chance of you developing a blood clot, however the chances of this happening are low. For most women it’s probably safer to use a patch than a tablet.

Are there any heightened risks involved with the HRT patch?

Skin patches are another common form of HRT. They work by applying them to your skin and replacing them every few days. You can get both combined and oestrogen-only HRT patches. If you find it difficult to remember to take a tablet every day, then skin patches might be a more convenient option for you. Due to the slow and continuous absorption of hormones, patches don’t increase your risk of a blood clot, so they can be considered a safer option.

Do I have to take progesterone with oestrogen gel?

Oestrogen gel is becoming an increasingly popular form of HRT. You use it by rubbing it onto your skin once a day. Like patches, it doesn’t increase your risk of blood clots. As oestrogen gel is an oestrogen-only treatment. If you haven’t had a hysterectomy you’ll need to take progesterone separately alongside this form of HRT to reduce your risk of developing womb cancer.

What are the risks of vaginal oestrogen?

Vaginal oestrogen comes in the form of creams, pessaries or rings. Each of these work by being inserted inside your vagina. Vaginal oestrogen is good for relieving vaginal dryness, but it isn’t very effective at helping with other menopausal symptoms like hot flushes. This form of HRT doesn’t carry the usual risks, and it doesn’t increase your risk of developing breast cancer. Even if you still have your womb, you can still use vaginal oestrogen without having to take progesterone.

Long-term pessary use has also proven to be a safe and effective way to relieve vaginal dryness and maintain urinary health for menopausal women.

This page was medically reviewed by Dr Daniel Atkinson, GP Clinical Lead on August 02, 2022. Next review due on August 01, 2024.

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