HRT for Menopause: Exploring Risks, Side Effects, and Safety

Understanding the Safety of HRT During Menopause

Hormone Replacement Therapy (HRT) is a frequently recommended treatment for managing troublesome symptoms of menopause, such as hot flushes, night sweats, and mood swings. However, many women understandably have concerns regarding the safety of HRT and the potential risks or side effects associated with its use. The decision to start HRT should be made with a clear understanding of its benefits and the possible complications so you can balance the relief of symptoms with any associated risks. Your doctor will consider your medical history and personal circumstances to tailor the safest and most effective plan for you.

Potential Risks and Side Effects of HRT

As you consider HRT to manage menopause, it’s important to be aware of both common side effects and rarer, more serious risks. Short-term side effects can include breast tenderness, headache, bloating, and leg cramps. These usually resolve after a few weeks as your body adjusts to treatment. However, ongoing or severe symptoms should be reviewed with your doctor. Long-term risks of HRT may include an increased risk of breast cancer, blood clots, and stroke, particularly with some types and longer durations of therapy. Risk factors such as a personal or family history of cancer, cardiovascular disease, or clotting disorders should be discussed with your healthcare professional prior to commencing HRT.

Special Considerations: HRT, Age, and Personal History

The timing of starting HRT and the type used can make a difference in both efficacy and safety. Generally, the benefits of HRT outweigh the risks for healthy women under 60 years or within 10 years of menopause onset, especially when managing moderate to severe symptoms. Women with certain medical conditions may be advised to avoid HRT or to use it with extra precautions. The choice between combined HRT (oestrogen plus progestogen) and oestrogen-only HRT will depend on whether or not you have a uterus, as combined HRT protects against endometrial cancer. Individual risk factors, dosage, and the form (patch, tablet, gel) must all be considered to optimise both relief from symptoms and overall safety.

Monitoring and Reducing HRT Risks

Women on HRT should have regular reviews with their healthcare provider. These check-ups track blood pressure, breast health, and any new symptoms. If risks increase or side effects become troublesome, your treatment plan may need adjusting. Healthy lifestyle measures—like exercise, not smoking, limiting alcohol, and maintaining a healthy weight—also play a key role in minimising complications associated with HRT. For many women, HRT offers significant improvements in quality of life during menopause, with most side effects being mild and manageable, especially with ongoing medical oversight.

Frequently Asked Questions About HRT Safety

Is HRT safe for everyone?

HRT is effective for many women but isn’t suitable for everyone. If you have a history of certain cancers, blood clots, or liver disease, HRT may pose higher risks. Discuss your full medical history with your doctor to find the best option.

What are the main side effects of HRT?

The most common side effects include breast tenderness, headaches, bloating, and nausea. These are often temporary and improve with time. Rarely, more serious effects like blood clots or breast cancer may occur, particularly with long-term use or in those with additional risk factors.

Does HRT increase cancer risk?

Combined HRT (oestrogen and progestogen) can slightly increase the risk of breast cancer, whereas oestrogen-only HRT may raise the risk of endometrial cancer if you still have your uterus. Your doctor will weigh the benefits and risks based on your medical history.

How can risks be reduced while on HRT?

To lower risks, use the lowest effective dose for the shortest duration needed and attend regular check-ups. Adopting a healthy lifestyle (no smoking, regular exercise, balanced diet) also reduces overall risk.

How often should HRT be reviewed?

Regular reviews are important for monitoring your health and adjusting treatment if necessary. Most women are reviewed every six to twelve months or sooner if new symptoms arise or change.

What alternatives exist if I cannot take HRT?

If HRT isn’t suitable, non-hormonal options and lifestyle changes can help. These include medications for hot flushes, natural remedies, and support for sleep or mood symptoms. Your doctor can discuss alternatives tailored for your needs.

References

Rees, Margaret et al. Management of the menopause: the role of HRT, risks and benefits. Practical guidelines for the menopause. 2022.
Hamoda, Haitham et al. The British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy in menopausal women. 2020.