HRT is an effective and widely used treatment for menopause symptoms including hot flushes, sleep problems and mood changes. Despite the fact that around a million women in the UK use HRT, myths and misunderstandings are common. We give you the facts behind some of the most common misconceptions about HRT.
Does HRT cause breast cancer?
A common concern is about the link between HRT and breast cancer.
1 in 7 women in the UK develop breast cancer over the course of their lifetime. This is known as the baseline or background risk. Your own personal breast cancer risk depends on a number of different factors. For example, your risk is higher if you are overweight, drink alcohol or have a strong family history of breast cancer.
If you are at low risk, the benefits of HRT are generally thought to outweigh the risks. If you are at higher risk, it is worth having a discussion with your doctor about the best approach for you.
Oestrogen-only HRT and breast cancer risk
Oestrogen-only HRT (used if you have had your womb removed) is associated with little or no change in your risk of breast cancer if used for up to five years. Data is still being collected on use beyond 5 years.
Combined HRT and breast cancer risk
HRT which contains both oestrogen and progesterone does marginally increase your risk. But what does that mean?
If you took one thousand women in their 50s and monitored them for five years, 23 would be expected to develop breast cancer, even if they didn’t take any hormonal medications (the baseline risk). If that same thousand women were all taking combined HRT (oestrogen and progesterone), an extra four out of the thousand would develop breast cancer.
To put this into context:
- 5 extra cases would be diagnosed if all of the women drank two or more units of alcohol per day
- 24 extra cases would be diagnosed if they were all overweight or obese
It is also worth noting that modern types of progesterone which are identical to those found in the body (micronized progesterone) are now thought to be lower-risk than older, synthetic forms of the hormone.
Your risk returns to that of someone who has never taken HRT within five years of stopping treatment.
Vaginal HRT and breast cancer risk
Vaginal HRT is widely used and comes with no additional breast cancer risk. This is because of the type of hormones used, and the fact that they are not absorbed into the bloodstream.
Read more about the different types of HRT here.
Does HRT increase the risk of cardiovascular disease?
HRT is not thought to cause any increase in your cardiovascular risk. If started before the age of 60 or within 10 years of your last period, it may actually reduce your risk and slow down atherosclerosis (the age-related furring-up of blood vessels).
Despite this, HRT is only a small part of the story. Your cardiovascular risk depends on a number of factors including your blood pressure, family history, weight, smoking history and other medical conditions. Your doctor will be able to help you decide on the best way to protect and improve your cardiovascular health.
Does HRT make you gain weight?
HRT does not cause weight gain. In fact, it can reverse some of the changes in fat distribution that happen at menopause, when fat tends to accumulate around your waist.
It is, however, very common to see changes in your weight around this time – a gain of about half a kilo (one pound) per year is normal in middle age. This is down to a combination of reasons, not all of which are related to your changing hormone levels.
Changes that contribute to weight gain include:
- Increased hunger
- Age-related decline in metabolic rate
- Reduced physical activity
If you are struggling with your weight, see your doctor for guidance and support.
Read about the best exercise during menopause here.
Can HRT be used long term?
As is the case for most medications, the general recommendation with HRT is to take the lowest dose possible for the shortest possible time. However, HRT can be taken for as long as needed to control your symptoms if the benefits still outweigh the risks.
There is no set age at which you must stop HRT. However, the risk-benefit profile of HRT does change over time, with risks steadily increasing as you age.
For this reason, your doctor will schedule an annual HRT review. At these appointments, they will review your general health and any changes (e.g. new medical conditions) which may make HRT higher risk for you.
If you have had an early menopause (before the age of 45), your doctor will likely recommend taking HRT for longer than other people – at least until the average spontaneous age of menopause (51 in the UK). This is because early menopause can increase your risks of osteoporosis and cardiovascular disease. Taking HRT helps to prevent this.
Vaginal HRT (in the form of oestrogen gels, creams, pessaries and rings) is very low risk. This is because of the type of oestrogen used, and the fact that it is not absorbed into the bloodstream.
Vaginal HRT is so safe that many women use it for decades with no concerns – even into their eighties and beyond.
Read our guide to when and how to stop taking HRT.
Start your free online menopause assessment to see if HRT is right for you
Is HRT unnatural?
One commonly-held belief about menopause is that it is a natural part of life, and that we should all simply grit our teeth and get on with it. But by the same logic, illness and disease are both ‘natural’ parts of life, for which we now happily have many effective treatments!
Menopause symptoms can be disruptive and distressing. If this is the case for you, it is absolutely reasonable to consider treatments including HRT.
This is not just a philosophical discussion – even the medications used for HRT are becoming closer in structure to the hormones produced by our own bodies.
Most of the oestrogens used in HRT today are ‘body identical’ and derived from plants (including soy beans and yams). This means that the type of oestrogen in the medication is identical to that produced naturally by your body. The most commonly-used is 17 beta-estradiol, and this can be supplied in the form of pills, patches, sprays and gels. The HRT prescribed through Stella+ uses this type of body identical oestrogen.
In contrast, ‘synthetic’ or manmade oestrogens are used for a number of other products, including the combined contraceptive pill. Other, older products can include ‘naturally occurring’ oestrogens which are thought to come with higher risks, as well as ethically unpalatable sourcing (as many are extracted from the urine of pregnant mares).
Many women also need to take progesterone alongside oestrogen as part of their HRT. Micronised progesterone (also known as Utrogestan) is a body identical type of progesterone, meaning that it is identical to the progesterone produced by your body. It can be taken orally or – in some cases – vaginally. Evidence is still emerging, but a review found that micronised progesterone comes with an even lower risk of breast cancer than other types of progesterone.
While HRT is the most effective way to reduce menopausal symptoms, it isn’t the only option. Hormone-free treatments for menopause include other medications, CBT and lifestyle changes.
Read more about body identical HRT.
Can I take HRT when my symptoms are mild?
HRT can provide relief for both mild and severe symptoms. If HRT is a suitable treatment for you, it’s up to you when you start. Some people choose to start early, while others prefer to wait until things get worse. Both of these are reasonable choices.
The most important thing is to weigh up the risks of HRT treatment against its benefits in your personal case. This varies from person to person and depends on your lifestyle and medical history as much as your menopause symptoms. It can be complicated, so your doctor will help you figure out the best decision.
Does HRT work straight away?
HRT is the most effective treatment we have for menopause symptoms, but it can take a while to start working.
Some people will feel better within a few days of starting, whereas others may find it takes weeks or even months. This is because it can take time for your body to adjust to the new hormones being supplied by your HRT.
If you have not felt any (or enough) benefit within three months of starting, speak to your doctor. They may be able to suggest a different dose or type of HRT. They might also want to re-evaluate your symptoms to check that they really are being caused by menopause.
Final word
We hope that this post has debunked some common misunderstandings about HRT. If you still have questions or would like to find out if HRT is an option for you, email hello@onstella.com or speak to your own doctor. Thank you!
Find out more about menopause on our blog or in our symptoms library.
Cancer Research UK page on risk and breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/risks-causes/risk-factors
National Institute for Health and Care Excellence (2019) Menopause: diagnosis and management (NICE Guideline 23). Available at: https://www.nice.org.uk/guidance/ng23 [Accessed 4th January 2022]
Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 75-76, 82-99, 130-140 and 158-165
P. Stute, L. Wildt & J. Neulen (2018) The impact of micronized progesterone on breast cancer risk: a systematic review, Climacteric, 21:2, 111-122, DOI: 10.1080/13697137.2017.1421925
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