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A doctor’s guide to Hormone Replacement Therapy (HRT)

Written by Babylon Health Team US

, 6 min read

A doctor’s guide to Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is one of the most effective ways to treat menopause. However, people can still feel uncertain about whether it is the right thing for them or not.

We asked Dr. Elise Dallas, our Women’s Health Lead GP a few questions about HRT and why it is a good thing for people going through menopause.


1. How does HRT work?

Hormone replacement therapy does what it sounds like. During menopause, your estrogen levels drop. As hormones affect every cell in our body, this can cause a lot of different symptoms as you can see from our menopause symptom checklist here. HRT works by replacing the estrogen which has been naturally depleted as a result of menopause.

In people who still have a womb, combined HRT is used. This contains estrogen and progesterone. While progesterone itself doesn’t improve many of the menopausal symptoms directly, it does help protect the lining of your womb.

Some HRT regimes also include testosterone but this generally needs to be started by a specialist first.1


2. Is HRT safe?

Let’s address the elephant in the room - HRT has had some bad press. Studies in the early 2000s were published highlighting the potential risks of hormone replacement therapy and as a result, some women and doctors have been reluctant to use HRT.

However, more recent published findings about the newer types of HRT, including body-identical HRT, show that although not entirely risk-free, it remains the most effective solution for the relief of menopausal symptoms. It can also help in the prevention of osteoporosis and provide protection against heart disease and possibly even dementia (although further research is needed on that one).2 If it is started under the age of 60, the benefits will outweigh the risks for many people.


3. Is HRT right for me?

Starting HRT can feel like a big decision but it is an important one to consider for all women. As with all medications, a decision about whether or not it is right for you will be made by you and your doctor, taking into account your medical history and preferences.

In general, if you are in your mid-40s and have menopausal symptoms, with or without periods, I would suggest considering HRT - it is not dangerous as long as you don’t have any pre-existing conditions or risk factors which would mean it is not suitable to take HRT.

If you decide to go ahead with HRT treatment, you can generally begin a trial of HRT as soon as you start experiencing menopausal symptoms and usually will not need to have any tests first. We explain why here. If your symptoms improve, we will soon know whether they are due to perimenopause or not.


4. How long can I stay on HRT?

It is now agreed that there is no definitive duration of use or age cut-off for HRT and it should not be discontinued solely based on someone’s age. Extended use of HRT beyond 65 years should be individualized and risks assessed on a person by person basis. Persistent symptoms such as hot flashes or need for bone protection are indicators for ongoing treatment.


5. What are the benefits of taking HRT?

Hormones affect our bodies all the time (and not just around your menstrual cycle) so the implications of having a low estrogen for a third of your life can be significant.

Estrogen receptors are in every cell of our body. This is why you can experience so many different symptoms when levels are fluctuating during perimenopause. Taking HRT can help manage vasomotor symptoms like hot flushes and night sweats as well as the low mood and anxiety that you may experience. Replacing estrogen also has long-term health benefits such as reducing your future risk of cardiovascular disease, osteoporosis and type 2 diabetes.

The most benefit is gained when you start HRT within 10 years of your menopause.4


6. Does HRT increase my risk of getting breast cancer, blood clots and strokes?

This is a really important question and we understand why this may be on your mind. The risks are usually very small and depend on the type of HRT you choose, how long you take it for and your own health risks.

Breast cancer risk:

  • If you do not have a womb and take estrogen-only HRT, there is little or no change in the risk of breast cancer.
  • Combined HRT (estrogen and progestogen) may be associated with a small increased risk of developing breast cancer. The increased risk relates to how long you take HRT, and it falls after you stop taking it. Taking bioidentical progesterone (otherwise known as micronized progesterone) has been shown to have the least risk.
  • Young women (under 51 years) taking HRT do not have a greater risk of breast cancer5

Blood clots:

  • Taking oral estrogen HRT can very slightly increase your risk of blood clots
  • There is no increased risk with transdermal estrogen HRT (patches or gels)
  • With micronized progesterone, there is no risk. 2

Heart disease and strokes:

  • When HRT is started before the age of 60 years, it does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) and may actually reduce your risk.
  • Taking estrogen HRT tablets is associated with a slight increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low. This means the overall risk is still small and seen mostly in the first year of taking the medication. Taking estrogen as a patch or gel eliminates this risk.6


As you can see, the type of HRT you are on can have different benefits and risks. There is good evidence showing that an estrogen patch or gel with a micronized progesterone is the best option for many people, including those with a risk of cardiovascular events. However, the right HRT regimen will vary from person to person. The good thing is, you don’t have to make this decision alone - Babylon offers high-quality, 24/7 comprehensive health care and one of our providers can assist you in navigating your choices. Let us help.

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References:

  1. HRT, NHS choices, Reviewed September 2019
  2. Benefits and Risks, NHS choices, Reviewed September 2019
  3. FSRH statement: we welcome reclassification of Gina 10microgram vaginal tablets, Issued July 2022
  4. BMS & WHC’s 2020 recommendations on hormone replacement therapy in menopausal women, British Menopause Society, Updated March 2021.
  5. Does hormone replacement therapy (HRT) increase cancer risk? Cancer Research UK, Reviewed March 2021
  6. Benefits and risks of HRT, NICE, Updated December 2019.

The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.

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