Hormone Replacement Therapy (HRT): Assessing the Pros and Cons

Hormone Replacement Therapy (HRT) is a common treatment here in the UK, especially for symptoms of menopause. But is it right for everyone? In this article, we'll look at the good and the not-so-good sides of HRT. By the end, you'll have a clearer idea about its benefits, its downsides, and whether it might be a good fit for you.

What is HRT and why would someone need it?

HRT stands for Hormone Replacement Therapy. It is a treatment used to alleviate the symptoms of menopause in women. Menopause is a natural part of ageing for women, usually occurring between the ages of 45 and 55, when a woman's oestrogen levels decline. In the UK, the average age for a woman to reach menopause is 51.

The most common reason women in the UK consider HRT is to relieve menopausal symptoms. These can include hot flushes, night sweats, mood swings, and vaginal dryness. Some women experience these symptoms severely, and they can have a significant impact on their day-to-day life.

Like all treatments, HRT isn't suitable for everyone and comes with its own set of risks. It's essential for women to discuss the potential benefits and risks with their GP or a menopause specialist before deciding to start HRT.

Video: Explaining HRT - British Menopause Society

The British Menopause Society have put together a helpful video to explain HRT. You can watch it below:

The Benefits of HRT

Does HRT maintain muscle strength?

The primary factor linking menopause to muscle strength is the decline in oestrogen levels. Oestrogen plays a role in maintaining muscle mass and strength. As the levels decrease during menopause, women might experience a reduction in muscle strength and mass. Oestrogen-based hormone replacement therapy (HRT) may play a role in maintaining and enhancing muscle mass and strength and protecting against muscle damage (Tiidus, 2011).

Does HRT prevent Osteoporosis?

Osteoporosis is a health condition that affects the bones, making them weak, fragile, and more prone to fractures or breaks. While menopause doesn't directly "cause" osteoporosis, the drop in oestrogen levels during menopause significantly accelerates bone density loss, increasing the risk of osteoporosis. Oestrogen-based HRT remains an effective treatment for preventing osteoporosis in women experiencing menopause (Stevenson, 2023).

Does HRT relieve the symptoms of menopause?

The menopause can cause a variety of different symptoms for women. Here are some of the most commonly experienced menopause symptoms:

• Hot flushes

• Night sweats

• Sleep disturbances

• Mood changes

• Vaginal dryness

• Reduced libido

• Cognitive changes (e.g., memory or concentration issues)

• Joint pain

• Irregular periods

• Palpitations

• Frequent urination or urinary tract infections

• Dry skin, eyes, or mouth

Hormone Replacement Therapy (HRT) is commonly prescribed to help alleviate symptoms of menopause (Harper-Harrison & Shanahan, 2023). While HRT can be effective in managing menopausal symptoms for many women, it's essential to discuss potential risks and benefits with a GP or menopause specialist, especially within the context of individual health considerations.

Does HRT cause Type 2 diabetes?

Menopause itself doesn't directly cause type 2 diabetes. However, the changes that occur during menopause and the associated ageing process can increase a woman's risk of developing type 2 diabetes. Hormone Replacement Therapy (HRT), does not cause type 2 diabetes. In fact, large, randomised controlled trials have indicated that MHT can delay the onset of type 2 diabetes in women (Mauvais-Jarvis et al, 2017).

The Risks of HRT

Does HRT cause breast cancer?

The relationship between Hormone Replacement Therapy (HRT) and breast cancer is nuanced, and the risk varies depending on the type of HRT, its duration, and other individual factors. HRT can increase the risk of breast cancer, but the magnitude of this risk varies depending on the type and duration of HRT and individual factors (Hou et al, 2013). It is important to understand that the type of HRT you use will vary depending on how much of a risk they pose, and your doctor will be able to provide you with tailored advice.

Does HRT cause stroke?

HRT, both combined and oestrogen-only, has been associated with a slightly increased risk of stroke. However, oestrogen delivered through patches or gels might pose a lower risk than oral variants. The actual risk is influenced by individual factors, with younger post-menopausal women generally at a lower baseline risk (Henderson & Lobo, 2012). 

Does HRT cause blood clots?

HRT has been linked to an increased risk of blood clots, specifically conditions such as deep vein thrombosis (DVT) and pulmonary embolism. The risk is particularly pronounced with oral forms of HRT and is highest during the first year of treatment. Factors such as age, obesity, and genetic predispositions can further elevate this risk. However, transdermal methods of HRT administration, like patches or gels, typically pose a lower risk of blood clots compared to their oral counterparts (LaVasseur et al, 2022).

Does HRT cause coronary heart disease?

Early observational studies suggested HRT might be protective against CHD, but later randomised controlled trials indicated an increased risk, especially in older post-menopausal women who started HRT several years after menopause. The risk appears to be lower for younger women who begin HRT closer to the onset of menopause. Additionally, the form of HRT matters: combined oestrogen-progestogen therapy may pose a higher risk than oestrogen-only treatments. Transdermal methods, such as patches, might offer a lower risk compared to oral tablets. 

Does HRT cause dementia?

Some studies have suggested that HRT might increase the risk of dementia, particularly in older women who begin the therapy well after the onset of menopause (Compton et al, 2001). On the other hand, there's no robust evidence indicating that HRT increases the risk of dementia when initiated in women under 65. Additionally, certain research has shown no association between HRT and dementia, with some even hinting at potential protective effects. Due to these varied findings, it's vital for women in the UK and elsewhere to consult with their GP or menopause specialist. 

Is there a shortage of HRT?

Yes, as we have previously mentioned in an article last year, the United Kingdom experienced a shortage of HRT products that left countless women unsure of where they could get their treatment. In 2023, there is less of a shortage, however, there is still a lack of certain products including some patches and creams.

What forms is HRT available in and what are the advantages and disadvantages of each?

Here is a handy table that outlines all of the forms of HRT you can get, as well as the advantages and disadvantages of each form.

Video: Practical Prescribing of HRT  - British Menopause Society

The British Menopause Society has put together a helpful video to explain practical prescribing of HRT.

Do I need HRT?

Determining whether you need Hormone Replacement Therapy (HRT) is a personal decision best made in consultation with a healthcare professional. Several factors influence this decision, including the severity of your menopausal symptoms, your medical history, and any associated risks. If you're considering HRT due to menopausal symptoms, it's imperative to seek guidance from your GP or a menopause specialist in the UK to ensure that any choice made is tailored to your unique health situation. You can also take our free quiz that can give you some tailored advice about whether to speak to your doctor.

Is HRT available online?

Yes, numerous HRT products are available to purchase online from UK Meds. Each of these HRT products has different advantages that may be perfect for you. Here are the HRT products you can buy online from UK Meds:

• Evorel

• Femoston

• Kliovance

• Elleste Solo

• Elleste Duet

• Zumenon

• Livial

• Premarin

• Evorel Conti

• Premique

• Estradot

• Elleste Solo MX

• Evorel Sequi

Sources

• Benefits and Risks of HRT (NHS)

• Types of HRT (NHS)

• Benefits and Risks of HRT (NICE)

• Benefits and Risks of HRT (BMS)

• HRT: Safe Use in Menopause (Oxford University)

• HRT Therapy: Risks and Benefits (NHS Fife)

• HRT and Muscle Health (NCBI)

• HRT and Osteoporosis Prevention (NCBI)

• Hormone Replacement Therapy (HRT) (NCBI Book)

• HRT and Breast Cancer Risk (NCBI)

• HRT and Breast Density (NCBI)

• HRT and Cardiovascular Health (NCBI)

• HRT and Stroke Risk (NCBI)