• Menopause Symptoms

The Pros & Cons of HRT for Menopause: A Balanced View

Pros and cons of hrt

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According to recent data published by the NHS, more than 1.9 million women were prescribed Hormone Replacement Therapy (HRT) in the UK in 2021-2022 – a number that’s increasing year upon year. So, why are so many people choosing HRT as a method of banishing the pesky symptoms that come with menopausal hormone deficiency? And how do you know if it’s right for you?

In this article, we’ll take you through the different types of HRT, how hrt works, the risks and benefits, and what else you can do to relieve symptoms and start feeling like yourself again. Let’s get straight to it.

What is Hormone Replacement Therapy? (HRT)

pros and cons of hrt
HRT is an important treatment that is used to help women by relieving symptoms of the menopause. For many women, it’s the most effective way to manage menopause symptoms , because it works by replacing the female hormones oestrogen and progesterone that are lost during perimenopause and remain low in menopause – namely oestrogen and progesterone.

There are two main types of HRT – oestrogen-only HRT, and continuous combined HRT, which contains the hormone oestrogen and the hormone progestogen. Testosterone can also be part of an HRT treatment plan.

Oestrogen-only HRT ( Estrogen Only HRT)

As the name suggests, oestrogen is the only hormone included in this form of oestrogen only HRT. This oestrogen replacement is usually only recommended to women who have had a hysterectomy as they don't need to protect the lining of the womb.

Oestrogen and progestogen HRT

This type of HRT – sometimes called combined oestrogen progestogen therapy or continuous combined hrt. Combined hrt contains both oestrogen and a synthetic version of natural progesterone called progestogen. This is the most common form and helps to protect the womb lining as well.

If you make the choice to start HRT, you’ll usually get to choose between the use of tablets, gels, or hrt patches (transdermal oestrogens) . If you opt for tablets, you’ll take them every day in accordance with your doctor’s or healthcare professionals instructions. HRT gels are also designed to be used daily – usually on the back of your arm or your inner thigh. HRT patches, on the other hand, are applied to the skin just below the waist, and only need to be changed once or twice a week.

Many women swear by HRT and describe it as life-changing. In general, the benefits far outweigh the risks, but that doesn’t mean it’s right for everyone, and it’s important you make an informed choice.

Vaginal oestrogen tablets

Vaginal oestrogen tablets contain a low dose of estradiol oestrogen and help to treat women with menopausal symptoms of vaginal dryness. Vaginal dryness can be really sore and is often accompanied by recurring urinary symptoms which can include skin irritation, burning, itching and painful intercourse. These hrt products can be bought over the counter in your local pharmacy, you don't need to see a specialist doctor or healthcare professional. Read more about GINA

What are the benefits of HRT during menopause?

Effective relief of menopause symptoms

The main advantage of Hormone Replacement Therapy (HRT) is its ability to reduce your risk of hormone related health problems like cardiovascular disease and osteoporosis.

It also safeguards you against other diseases like type 2 diabetes. As your oestrogen supply declines you don't metabolise sugar as well which can increase your risk of developing diabetes. Women on HRT are also more protected against bowel cancer Alzheimers disease.

Short term though, HRT hormones can help to make a big difference in a few weeks. They alleviate and can make disappear altogether, confidence sapping and uncomfortable menopausal symptoms, including:

  • Mood swings
  • Anxiety
  • Hot flushes and night sweats
  • Brain fog
  • Vaginal dryness
  • Dry skin
  • Joint and muscle aches
  • Loss of libido
  • Low energy levels

Protects you against osteoporosis

Because it replaces lost oestrogen in the body, taking HRT contributes to keeping your bones strong and healthy and reducing the risk of developing osteoporosis. Brittle bones are caused by bone renewal slowing down as oestrogen levels fall. One in 2 women over 50 will break a bone due to osteoporosis.

Helps to keep your heart healthy

High blood pressure is a concern for menopausal women, as lower levels of oestrogen can make blood vessel leading to the heart narrower and less flexible. HRT started within 10 years of menopause or before the age of 60 helps prevent heart disease, which is a big plus.

HRT is low maintenance

For most women, HRT is low maintenance. It’s non-invasive, and as long as you feel well, you’ll usually only need to attend check-ups once a year to make sure you’re on the right dosage.

What are the drawbacks of HRT?

Evidence shows that lifestyle factors such as being overweight, smoking, or drinking too much alcohol have a far greater impact on your risk of developing cancer and blood clots than HRT.

What about the breast cancer risk?

For many years women, the media and healthcare professionals were given incorrect information about the risk of HRT due to a study in the early 2000's. The study flagged concerns about an increased risk of cardiovascular disease and breast cancer in women who took continuous combined HRT.

However the HRT used in the study was an oral oestrogen and an older form of progestogen. The average age of the women on the trial was 63 and may were obese, overweight or had heart attacks in the past.

Taking HRT for a long time only very slightly increases the chances of developing breast cancer. When you stop hrt, your risk eventually returns to normal.

Louise Newson, the leading UK menopause specialist, maintains women who take oestrogen only hrt and are not taking progestogen to protect their womb lining (they have had a hysterectomy) have been shown to have a 25% LOWER risk of developing breast cancer.

Increased risk of blood clots

When taken in tablet form, HRT comes with an increased risk of developing a blood clot in the veins ( venous thromboembolism), particularly a blood clot in the legs. With this also comes an increased risk of strokes. If you choose to take it in patch or gel form, however, this risk is eliminated.

Hearing these risks might cause you to panic a little about taking HRT. However, remember that your doctor will look at all of your individual risk factors before prescribing HRT, and you won’t be offered it if the risks to your overall health outweigh the benefits.

HRT side effects

HRT does come with some side effects, especially when you first begin hrt. The good news is that these all tend to clear up after the first three months. If they don't it's best to consult with your doctor who may suggest a different type of HRT. The most common side effects include:

  • Breast tenderness
  • Bloating
  • Nausea
  • Headaches
  • Mood changes
  • Vaginal bleeding
  • Low energy levels

Is HRT alone enough to help menopause symptoms?

While HRT is a very effective treatment for many menopause symptoms, it’s not a magic cure. In fact, many women find that despite being on HRT, they still struggle with weight gain, anxiety, brain fog, and bloating. HRT also needs to be reviewed periodically if you start experiencing menopausal symptoms again to make sure you're on the right dose.

You’ll also need to make a few diet and lifestyle changes while on HRT. Your tolerance to alcohol decreases so you may need to moderate your drinking habits. Eating less sugar and less saturated fat to protect your heart. Making sure you get enough exercise to help manage stress levels and keep your weight down.

Hormone Replacement Therapy Not For You?

For some women, health reasons mean HRT isn’t an option. Other women choose to navigate menopause without taking hormones instead opting to change their diets and lifestyles to minimise symptoms of their gradually decreasing oestrogen supply.

Eating less sugar and red meat, increasing vitamins to support your brain function, increasing fibre to keep gut microbiome healthy, reducing alcohol, using meditation to manage stress and weight bearing exercises to keep bones strong will all help to counteract the challenges of your body's hormone recalibration. Eve Biology Meal Replacement Shakes For Menopause were formulated around these lifestyle recommendations.

  • Vegan Protein - Easy to digest, free from any additional hormones
  • Boosted with core vitamins - A,D, E, K, C, B6, B12, B5, B2, Folic acid, Iron
  • High in fibre - proven to increase microbiome and keep your regular
  • Herbal support - calm anxiety and increase focus
  • Low calorie - to support weight loss or weight maintenance after weight loss

The bottom line

So, there you have it – hormone replacement therapy is an effective treatment for many symptoms of menopause, from hot flashes to mood swings. And while it’s not without some risks, millions of women over 40 choose to take it to get address menopausal symptoms their lives back on track. If HRT isn’t an option for you or you choose to experience menopause without the support of prescribed hormones there are diet and lifestyle changes to counteract symptoms of low oestrogen which can make your menopause experience a lot easier.


What are the signs HRT is not working?

It can take a few months for HRT to start working fully. If several months have passed and you’ve still not noticed any improvement in your menopause symptoms, this could be a sign that it’s not working for you, and you should speak to your doctor to try to find out why.

Is there an age limit for starting HRT?

There’s no age cut-off to begin HRT. So, whether you’re thinking about starting HRT at 57 or in your 40s, there will be options available. Your age – among other circumstances – may affect which types of HRT are suitable for you, so it’s a good idea to speak to your doctor before considering your options.

What is the lowest dose of HRT hormones available?

HRT is prescribed in different doses depending on the individual’s circumstances. You’ll usually be given a lower dose to start with, and this can then be reviewed and tweaked every couple of years as oestrogen levels continue to decline with time and gain you start experiencing menopausal symptoms.