Understanding Hormone Replacement Therapy (HRT): Risks, Benefits & Myths

TL;DR – HRT can ease menopause symptoms and protect long–term health, but it isn’t one-size-fits-all. Talk to a qualified clinician before deciding.

1. What is HRT, exactly?

During perimenopause and menopause, levels of estrogen ± progesterone nosedive. HRT tops them back up with:

Type	What’s in it?	Common formats
Estrogen-only	Estradiol, conjugated estrogens	Patches, gels, pills, sprays
Combined	Estrogen + progesterone/progestin	Pills, patches, cyclic regimens
Body-identical (“bio-identical”)	Micronized 17β-estradiol + micronized progesterone	Patch + capsule/gel

(Body-identical means molecularly the same as what your ovaries made—not compounded or “custom-blended.”)

Source: NICE guidelines, North American Menopause Society

2. Why bother? Documented benefits

Relieves hot flashes & night sweats (≈ 80 % get ≥ 50 % reduction)
Improves sleep, mood, brain fog and energy
Prevents urogenital dryness and painful sex
Cuts fracture risk by boosting bone density
May reduce risk of type 2 diabetes and colon cancer
Earlier use (< 10 years since final period) is linked to cardio-protection in healthy women
See the “timing hypothesis” – JAMA

3. What are the risks?

Risk varies with age, route, dose and your health history.

Risk	Relative change	How to lower it
Breast cancer (combined HRT)	+4 extra cases/1,000 women over 5 yrs	Use body-identical progesterone, lowest effective dose, keep weight in check
Blood clots (oral estrogen)	2-3× higher	Use transdermal (patch/gel) estrogen
Stroke	Slight ↑ after age 60	Start before 60 or within 10 yrs of menopause, manage BP
Endometrial cancer	Only if estrogen given without progesterone in women with a uterus	Always pair with progesterone, or use the Mirena IUD

Source: Women’s Health Initiative, BMJ

Disclaimer: Statistics describe population risk; your personal risk can differ. Always discuss your medical history, family cancers, migraines, clotting issues, etc., with a licensed clinician.

4. Top myths—busted 🎉

“HRT is dangerous for everyone.”
Most healthy women under 60 have a favorable benefit-risk ratio.
“Natural supplements do the same thing.”
Black cohosh, soy, CBD, etc., lack the robust evidence HRT has. They can also interact with meds. NIH review
“You can only stay on HRT for 5 years.”
There’s no hard stop. Re-evaluate annually; some stay on for decades for bone, brain, or symptom control.
“Weight gain is guaranteed.”
Weight change is more linked to aging + lifestyle. Estrogen may even help body-fat distribution. Mayo Clinic

5. Is HRT right for you?

Consider HRT if you have:

Moderate-to-severe vasomotor symptoms
Premature menopause (< 40) – standard of care until natural menopause age
Early osteoporosis or high fracture risk
Disrupted daily life due to brain fog, mood swings or sleep

You may need alternatives if you have:

Active or past estrogen-dependent cancer
Uncontrolled hypertension, liver disease, or a history of unexplained clots
Migraine with aura ± stroke history (transdermal may still be possible—ask!)

See non-hormonal options: SSRIs, SNRIs, clonidine, gabapentin, cognitive behavioral therapy. NICE

6. Getting started: quick checklist

Book a menopause-trained GP, OB-GYN, or endocrinologist.
Bring symptom notes + family history.
Decide on delivery (patch, gel, pill, coil).
Review follow-ups: 3 months, then yearly. Mammograms & bone scans as advised.

7. Key takeaways

✅ HRT is the gold-standard for menopause symptom relief.
✅ Starting before age 60 or within 10 years of menopause maximizes benefits and minimizes risks.
✅ Route & formulation matter—patches and body-identical progesterone are friendlier options.
✅ Ongoing review is essential; HRT isn’t a forever prescription unless it still serves you.
✅ An informed chat with your clinician beats internet rabbit holes every time.

References & Further Reading

This article is for information only and does not replace personalized medical advice.