Hormone replacement therapy (HRT) is commonly prescribed to help relieve menopausal symptoms such as hot flushes, night sweats, mood changes, and difficulty sleeping. In addition to relieving symptoms, oestrogen therapy helps maintain bone density and can reduce the long-term risk of osteoporosis. This is particularly important for people who experience menopause early or who have lower oestrogen levels for medical reasons.
However, the health risks and benefits of taking HRT vary depending on your age, personal medical history, the type of HRT used, and how long you take it. Some forms may slightly increase the risk of breast cancer, blood clots, stroke, and heart disease, particularly with long-term use.
Because of this, it is important to understand both the advantages and the possible risks and to make decisions in consultation with a qualified healthcare provider.
Benefits of Taking Hormone Replacement Therapy
Hormone replacement therapy can offer meaningful improvements in daily comfort, long-term health, and overall quality of life. When appropriately prescribed and monitored, hormone therapy can support both physical and emotional well-being.
Relief From Menopause Symptoms
Many menopause symptoms are linked to declining oestrogen levels. These may include hot flashes, night sweats, sleep disturbances, irritability, and mood swings. By helping restore hormone levels, HRT can significantly reduce the intensity and frequency of these symptoms and support more stable day-to-day functioning.
Support for Vaginal and Sexual Wellbeing
Lower oestrogen levels can lead to vaginal dryness, irritation, discomfort with intimacy, and increased susceptibility to urinary tract infections. Local vaginal oestrogen or systemic HRT can improve lubrication and tissue elasticity and reduce discomfort.
This support may also enhance sexual confidence and daily comfort.
Bone Health and Osteoporosis Prevention
Oestrogen plays an essential role in maintaining bone density. When levels fall, bone thinning accelerates, increasing fracture risk. HRT can help slow bone loss and maintain bone strength, particularly in individuals who experience premature or early menopause or who have undergone a hysterectomy.
Early intervention may help reduce osteoporosis-related fractures over time.
Possible Improvements to Mood and Cognitive Function
For some individuals, stabilising hormone levels through replacement therapy may support emotional balance, improve concentration, and reduce feelings of anxiety or low mood.
While HRT is not used as a mental health treatment on its own, improved hormonal stability may have a positive flow-on effect on cognitive clarity and emotional well-being.
Potential Reduced Risk of Colorectal Cancer
Some research suggests that combined estrogen and progestogen therapy may be associated with a slightly lower risk of colorectal cancer. While this effect is considered modest, it is a potential benefit that continues to be studied in randomised controlled trials and large-scale population research.
Improved Quality of Life
For many people, HRT restores a sense of comfort, stability, and confidence. Improved sleep, fewer disruptive symptoms, and increased emotional resilience can make daily life feel more manageable and enjoyable.
Risks and Considerations Of Taking Hormone Replacement Therapy
While HRT can be highly effective, it is not the right option for everyone. Increased risk varies depending on:
- Type of HRT (combined vs oestrogen-only HRT)
- Method of delivery (oral vs transdermal)
- Age and timing of treatment initiation
- Duration and dose
- Individual risk factors and medical history
Breast Cancer
Long-term use of combined HRT has been associated with a small increase in breast cancer risk, particularly after 5+ years of use. The risk decreases again after stopping treatment. Oestrogen-only HRT (used after hysterectomy) appears to carry little or no increased breast cancer risk.
Regular breast screening remains important for early detection and reassurance.
Ovarian and Uterine Cancer
Taking oestrogen alone can increase the risk of endometrial cancer by stimulating the uterine lining.
For individuals with a uterus, progestin therapy is included to protect the womb.
There may also be a very slight increased risk of ovarian cancer, though this remains low.
Heart Disease and Stroke
Risk varies depending on age and delivery method:
- Starting HRT under age 60, or within 10 years of menopause, has the most favourable safety profile.
- Oral HRT can slightly increase the risk of stroke or coronary heart disease in some cases.
- Transdermal delivery (patches, gels, sprays) bypasses the liver and is associated with a lower cardiovascular disease risk.
Blood Clots (Pulmonary Embolism / DVT)
Oral HRT increases the risk of blood clots, including deep vein thrombosis and pulmonary embolism. Transdermal HRT has minimal effect on clotting and is often recommended when clot risk is a concern.
Side Effects
Temporary side effects may include:
- Nausea or bloating
- Headaches
- Breast tenderness
- Spotting vaginal bleeding
- Mood changes
These typically improve as the body adjusts. If they persist, dosage or formulation may be changed.
Duration and Dose Matter
Best practice is to use:
- The lowest effective dose
- For the shortest time needed to relieve symptoms
- With regular clinical review every 6–12 months
Who May Need Extra Assessment or Alternatives?
Hormone replacement therapy is not the right approach for everyone. In some situations, additional medical assessment is needed to determine whether HRT is safe or whether an alternative treatment pathway may be more appropriate. This ensures your care is personalised, safe, and aligned with your long-term health needs.
- History of Breast Cancer: Individuals who have previously been diagnosed with breast cancer may be advised to avoid HRT, as certain hormone therapies can increase the risk of cancer recurrence.
Non-hormonal options or localised therapies (such as low-dose vaginal oestrogen) may be considered with specialist guidance. - Previous Blood Clots or Clotting Disorders: Those who have experienced deep vein thrombosis (DVT), pulmonary embolism, or who have known clotting conditions may need to avoid oral HRT, as it can increase clotting risk.
Transdermal HRT (patches, gels, sprays) may be safer in some cases, but assessment with a healthcare professional is essential. - Uncontrolled High Blood Pressure: If blood pressure is not well managed, certain forms of HRT may not be recommended. Once blood pressure is controlled, many people can use HRT safely under medical supervision.
- Cardiovascular Disease Risks: People with a history of cardiovascular disease or elevated stroke or heart disease risk may need a cautious, personalised plan.
- Age and timing also play a role; starting HRT under age 60 or within 10 years of menopause generally has a more favourable profile.
- Individuals Who Prefer Non-Hormonal Options: Some may choose to avoid hormone therapy entirely.
- Evidence-based non-hormonal treatments, including certain medications, lifestyle strategies, and local therapies, can help manage symptoms such as hot flushes, sleep disturbances, and vaginal dryness.
Your healthcare provider can help guide whether HRT, a modified form of HRT, or a non-hormonal approach may offer the best balance of safety and symptom relief for your individual situation.
Need More Information About the Benefits & Risks of HRT? Contact McKenzies Compounding Chemist Today!
Every individual’s experience with hormone changes is unique, and the decision to start hormone replacement therapy should be guided by personalised care. If you are considering HRT or would like to explore custom-compounded formulations tailored to your symptoms and health profile, our pharmacists are here to help. We can work collaboratively with your healthcare provider to support safe, effective treatment planning.
Contact McKenzie’s Compounding Chemist to discuss your options, ask questions, and take the next step toward improved comfort and well-being!