5 things you need to know about HRT

1. NOT ALL WOMEN NEED HRT 

Many women don’t need HRT because they are not having menopausal symptoms. If you don’t have symptoms nor osteoporosis concerns, taking HRT means your risks from the medication are outweighing your personal benefits and doctors would not recommend it.

Along the spectrum of menopause symptoms, for some women they are mild enough that it isn’t worth thinking about taking a medication. For someone with only mild symptoms that don’t impact quality of life, the benefits are minimal. Many women are doing very well with their menopause using alternatives to HRT whether natural or prescribed. 

Choosing to take any medication is a balancing act of downsides and benefits, and if there aren’t great benefits to be had, the balance doesn’t swing in favour of taking something. 

2. HRT DOES NOT PREVENT AGEING

Many of the symptoms of menopause make us feel old. Poor sex drive, brain fog and aches and pains. Of course taking HRT which can reduce those symptoms will help us feel younger. But you shouldn’t take HRT unless your symptoms of menopause are bad enough that you need treatment. It isn’t an anti-aging potion that you take just in case. That’s because it comes with risks and side effects, and these have to be balanced by big benefits to you.

Dementia is something we are all afraid of and a frightening aspect of aging. Since we know HRT helps to reduce menopausal brain fog and concentration, people assume that it must therefore help to prevent dementia. But that isn’t the case. Science has shown so far that HRT both prevents but also causes dementia - in truth no-one is sure at this stage.

3. HRT IS LESS OF A RISK FOR BREAST CANCER THAN ALCOHOL OR BEING OBESE 

Taking some forms of HRT may increase your risk of getting breast cancer. This was always one of the big historical worries about HRT and is something the science has swung backwards and forwards on.

Looking at the figures tells us that the risk from HRT is less than the risks from being obese or drinking alcohol every day.

There are two types of HRT that do not increase your risk of breast cancer: Vaginal oestrogen HRT does not affect your breast cancer risk. And taking oestrogen-only HRT does not increase your risk of getting or dying from breast cancer.

Taking combined HRT - with oestrogen and a progestogen - can be linked to an increased risk of breast cancer. The important thing to know is that this is related to how long you take HRT for.

Your increased chances of breast cancer from HRT are considered low in statistical terms. In the UK about 2% of breast cancer cases in the UK are thought to be linked to use of HRT. 

4. YOU CAN BUY HRT OVER THE COUNTER 

Vaginal oestrogen is a type of HRT that is sometimes called topical HRT. It is only the hormone oestrogen and it is used either as a cream, a vaginal tablet or a ring that goes into the vagina.

For the last few years you have been able to buy this over the counter in pharmacies because it is considered very low risk even for women who may not be able to take other forms of HRT. It is excellent for the genital and urine symptoms of menopause such as irritable bladders, dry vagina and discomfort during intercourse. It can be used alongside other treatments such as vaginal moisturisers and lubricants as well as bladder treatments like pelvic floor physio.

5. HRT IS NOT A SUBSTITUTE FOR A GOOD LIFESTYLE 

HRT has a myriad of benefits not just in treating hot flushes and night sweats but also some of the other whole body symptoms of menopause such as insomnia, hair loss, and brain fog. But there are also many alternatives to HRT that you should think about alongside any hormone treatment - exercise and strength training are incredibly important as people get older for muscle bone strength. A diet rich in vitamin D, phytoestrogens and fibre are important and ensuring you have proper sleep through good sleep hygiene and reducing alcohol and caffeine can be as effective as any treatment for insomnia.