Benefits and risks of HRT

What are the benefits of HRT?

At Menoclinic, we’ve seen many women experience notable symptom relief within 3-6 months of beginning HRT.  We schedule a follow-up appointment 3 months after starting treatment to monitor its effectiveness.

The benefits of HRT extend beyond immediate symptom relief. It plays a crucial role in long-term health and well-being of women:

• Lowers risk of osteoporosis – delays the onset of osteoporosis, strengthens bones and reduces bone complications.
• Reduces risk of Cardiovascular disease- oestrogen protects the body’s blood arteries, lowering the danger of heart attacks, strokes and dementia.
• Type 2 Diabetes risk is reduced
• Risk of joint pain associated with osteoporosis is reduced.
• HRT may protect you from bowel cancer 
• HRT lowers anxiety and depression, improving mood, memory and concentration.
• HRT helps with sleep
• HRT can improve low libido, vaginal dryness and soreness as well as improve sexual satisfaction.

What are the Risks of HRT?

While HRT offers vast benefits for those going through menopause, it still, like any other medication, has risks and side effects. These risks are often related to how your body reacts to treatment, the dose of HRT, and the type of HRT used.

For most women taking HRT within 10 years of their last period, the benefits are greater than the risks of being oestrogen deficient.

Key risks associated with HRT:

Breast Cancer

Decades of conflicting and inconsistent data has led women not to take HRT.

In truth the risk of breast cancer with HRT is relatively low. In a group of 1,000 women taking combined HRT for five years; only about 3-5 additional women may develop breast cancer compared to those not on HRT.

The risks of HRT depend on:

• Type of HRT prescribed. Topical Oestrogen (creams, patches and gels) lower the risk of breast cancer than oral forms. This is because the oestrogen is absorbed directly through the skin and into the bloodstream instead of being processed by the liver, meaning that a smaller dose is needed to achieve the best results. During your consultation with our specialists, we’ll look comprehensively at your medical history to determine whether the benefits of HRT outweigh the risks of breast cancer before writing your prescription for the most appropriate form of HRT.
• Risk is associated with the type of progesterone in HRT.  Body identical progesterone, also known as micronised lowers the risk of invasive breast cancer.  For women taking synthetic progesterone, the risk is very low. Overall the risk of breast cancer due to HRT remains low.  Some women may be at a greater risk of developing breast cancer with HRT
• Age and the onset of perimenopause symptoms and menopause.
• Lifestyle choices such as smoking, diet and exercise, and alcohol intake  
• Family history of breast cancer

Although breast cancer is sadly common, there are steps we can take to lower our risk through our lifestyle choices. Maintaining breast health; examining your breast at the same time each month so you can recognise any changes and attending mammogram appointments. Avoid smoking and reduce alcohol consumption. Maintaining a healthy weight and being active.

It is also important to remember that HRT does not raise the risk of breast cancer in the majority of women.HRT, Hormonal replacement therapy is a safe and successful treatment for perimenopause and menopause. Discuss the risks and benefits with our menopause practitioner.HRT replaces the oestrogen and progesterone in the body.

Blood Clots

The risk of blood clots with HRT varies based on the type of HRT you’re taking and your overall health. If you’re taking oestrogen oral tablets, there’s a slight risk of a clot or stroke. This is because oestrogen, is metabolised in the liver — the organ responsible for producing blood clotting factors. High levels of oestrogen in the liver can lead to sticky blood changes that increase the risk of VTE (Venous Thromboembolism).  

This does not occur with transdermal oestrogen preparations such as patches, gel or spray.

HRT in this form delivers oestrogen straight into your bloodstream, bypassing the liver and not affecting clotting factors. Therefore does not increase the risk of clot.

For women who are at a higher risk of clots or have had clots in the past, transdermal HRT may be the safest option. 

If you still have your womb, you also need to take progesterone. This helps keep the lining of your womb healthy. The newer micronised progesterone (known as Utrogestan™) does not have this risk. 

To understand the risk, consider a healthy 50-year-old woman. Her risk of experiencing a VTE (clot) is approximately 6 in 10,000 per year. If she took oral oestrogen tablets, this would double her risk to around 12 in 10,000. It’s important to note that the overall risk remains small.

Strokes

HRT dosage, regimen and duration should be personalised, evaluating the benefits and risks of each woman.

When looking at the risk of stroke while taking HRT, it is important to bear in mind your age and type of HRT. HRT in tablet form might slightly increase the risk of having a stroke, but this risk is quite low, if you’re under 60 years old.  Transdermal HRT in the form of patches, sprays, or gels, does not increase the risk of stroke.

Research shows that HRT can actually lower your risk of cardiovascular disease.  The risk is less than 1 in 1,000 women.

If HRT is prescribed before the age of 60, it has favourable benefits verses risk profile.

HRT initiated before the age of 60 or within 10 years of menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.

Diabetes

HRT is protective against some chronic diseases. Recent studies surrounding HRT and Type 2 diabetes are encouraging. Not only does HRT not increase the risk of Type 2 Diabetes, but it might even slightly reduce the risk. 

Perimenopause and menopause do not cause Type 2 Diabetes, it is the hormonal changes, like carrying more weight around the stomach and high blood pressure that increase the risk of Type 2 Diabetes. 

However, it’s worth noting that when it comes to Type 1 Diabetes, the evidence isn’t as clear yet.

Others

HRT has also been linked to a lower risk of dementia. Since dementia affects more women than men, hormones might play a key role in this. Although we need more research to fully understand this connection, it’s promising.

What are the side effects of HRT?

Side effects with HRT are uncommon but when you first start HRT, these can include breast soreness, irregular bleeding or ‘spotting’. Sometimes women report PMS type symptoms and some women complain of fluid retention. Side effects often settle with time but if they don’t, alternative preparations of HRT can be tried after discussion with your Menopause specialist or doctor.