Debunking HRT myths

Despite almost a century of use and proven benefits in managing menopause and preventing osteoporosis, hormone replacement therapy (HRT) remains shrouded in misconceptions stemming from outdated studies and media sensationalism. Here, we debunk the top 10 myths surrounding HRT to provide clarity and confidence for those considering this treatment.
woman looking off into distance holding HRT tablets

What is HRT?

Hormone replacement therapy (HRT) is a medical treatment used to alleviate the symptoms associated with perimenopause and menopause. As the drop in oestrogen during menopause is a significant factor contributing to bone loss, HRT can also be implemented as an effective treatment for the management or prevention of osteoporosis. 

HRT involves supplementing the body with oestrogen, progesterone, testosterone, or a combination of these hormones to restore hormonal balance and improve quality of life.

What is HRT?

Hormone replacement therapy (HRT) is a medical treatment used to alleviate the symptoms associated with perimenopause and menopause. As the drop in oestrogen during menopause is a significant factor contributing to bone loss, HRT can also be implemented as an effective treatment for the management or prevention of osteoporosis. 

HRT involves supplementing the body with oestrogen, progesterone, testosterone, or a combination of these hormones to restore hormonal balance and improve quality of life.

Why are some people wary of HRT?

Despite the fact that HRT has been in use for the treatment of menopause for over 80 years, there is still confusion and controversy about its risks.

Preliminary findings from a Women’s Health Initiative study in 2002 reported that certain types of HRT were associated with an increased risk of breast cancer and coronary heart disease. Benefits were also found, such as a reduction in osteoporosis and incidence of colorectal cancer. But seemingly it was concluded that the risks outweighed the benefits which sparked an unruly media storm. Stories with sensationalist headlines put the message forward loud and clear that HRT was dangerous, causing use of HRT to drop dramatically.

Fast-forward to today and reworking of the data and subsequent published studies have shown the risks to be smaller, not significant or untrue for most women. Researchers involved in the 2002 Women’s Health Initiative study have even come forward to voice that the results were misreported1. Even so, these initial findings have left a lasting impact on public perception. 

woman reading leaflet about HRT

Why are some people wary of HRT?

Despite the fact that HRT has been in use for the treatment of menopause for over 80 years, there is still confusion and controversy about its risks.

Preliminary findings from a Women’s Health Initiative study in 2002 reported that certain types of HRT were associated with an increased risk of breast cancer and coronary heart disease. Benefits were also found, such as a reduction in osteoporosis and incidence of colorectal cancer. But seemingly it was concluded that the risks outweighed the benefits which sparked an unruly media storm. Stories with sensationalist headlines put the message forward loud and clear that HRT was dangerous, causing use of HRT to drop dramatically.

Fast-forward to today and reworking of the data and subsequent published studies have shown the risks to be smaller, not significant or untrue for most women. Researchers involved in the 2002 Women’s Health Initiative study have even come forward to voice that the results were misreported1. Even so, these initial findings have left a lasting impact on public perception. 

woman reading leaflet about HRT
woman putting on HRT patch

Myth #1: HRT causes breast cancer

To explain the risks of breast cancer, we first have to explain the different types of HRT. 

There are two main types of HRT – combined HRT (oestrogen and progesterone) and oestrogen-only HRT, which is normally taken by women who have had their womb removed. 

If you take combined HRT, your risk of breast cancer is ever so slightly increased but still low. To put that into context, you are more at risk of developing breast cancer from lifestyle factors such as being overweight, inactive or drinking alcohol than from taking HRT. Oestrogen-only HRT causes little or no increased risk2

Myth #2: HRT will make me put on weight

Some women have a tendency to gain weight in midlife, but there’s no evidence that HRT is responsible for this. It is most likely due to other factors such as decreased physical activity and the menopause itself3.

Myth #3: HRT only delays the menopause

There is no evidence that HRT hits the brakes on menopause, it simply masks the symptoms. When you decide to stop taking it, you’ll likely experience how you would have felt at that point if you had never taken HRT. 

woman putting on HRT patch

Myth #1: HRT causes breast cancer

To explain the risks of breast cancer, we first have to explain the different types of HRT. 

There are two main types of HRT – combined HRT (oestrogen and progesterone) and oestrogen-only HRT, which is normally taken by women who have had their womb removed. 

If you take combined HRT, your risk of breast cancer is ever so slightly increased but still low. To put that into context, you are more at risk of developing breast cancer from lifestyle factors such as being overweight, inactive or drinking alcohol than from taking HRT. Oestrogen-only HRT causes little or no increased risk2

Myth #2: HRT will make me put on weight

Some women have a tendency to gain weight in midlife, but there’s no evidence that HRT is responsible for this. It is most likely due to other factors such as decreased physical activity and the menopause itself3.

Myth #3: HRT only delays the menopause

There is no evidence that HRT hits the brakes on menopause, it simply masks the symptoms. When you decide to stop taking it, you’ll likely experience how you would have felt at that point if you had never taken HRT. 

Myth #4: ‘I hate taking tablets so HRT isn’t for me’

HRT comes in patches, creams, gels, vaginal rings and coils4, allowing for personalised treatment based on individual preferences, so you don’t have to take tablets if you don’t want to. 

Myth #5: HRT causes blood clots, heart attack and stroke

Taking HRT under the age of 60 or within 10 years of the start of menopause actually reduces your risk of cardiovascular disease5. Taking HRT in tablet form, as opposed to patches, gels or sprays, can slightly increase the risk of stroke and blood clots, but this risk is very low.

Myth #6: You should wait until your menopause symptoms are unbearable before seeing your doctor about HRT

You don’t need to wait until your symptoms are severe to start HRT – it can help even the mildest of symptoms. Also, the earlier you start it, the more benefits there are in protecting bone health, especially for women under 506

woman holding HRT tablets

Myth #4: ‘I hate taking tablets so HRT isn’t for me’

HRT comes in patches, creams, gels, vaginal rings and coils4, allowing for personalised treatment based on individual preferences, so you don’t have to take tablets if you don’t want to. 

Myth #5: HRT causes blood clots, heart attack and stroke

Taking HRT under the age of 60 or within 10 years of the start of menopause actually reduces your risk of cardiovascular disease5. Taking HRT in tablet form, as opposed to patches, gels or sprays, can slightly increase the risk of stroke and blood clots, but this risk is very low.

Myth #6: You should wait until your menopause symptoms are unbearable before seeing your doctor about HRT

You don’t need to wait until your symptoms are severe to start HRT – it can help even the mildest of symptoms. Also, the earlier you start it, the more benefits there are in protecting bone health, especially for women under 506

woman holding HRT tablets

Myth #7: You should not start HRT too young

Most women start to experience menopause symptoms in their mid-to-late 40s7, but it can be earlier. It is important for women who experience early menopause or have had a hysterectomy to consider HRT. Younger women will be more at risk of osteoporosis because their ovaries are not making enough oestrogen and HRT can help to top up these hormones. 

Myth #8: You can only take HRT for 5 years

HRT can be taken for as long as the benefits outweigh any risks, which means many women happily take it for more than five years. 

Younger women on HRT should not stop before the age of 50, to protect themselves from bone loss8

Myth #9: You need a thorough examination to ensure you are suitable for HRT

You can usually begin HRT as soon as you start experiencing menopausal symptoms if you are over the age of 45 without the need for any tests. A blood test may be carried out if you are aged 40-45, or used to diagnose premature menopause in people under 409.

Myth #10: If you’re taking HRT, you no longer need contraception

HRT isn’t a contraceptive, unless you use the Mirena coil. You can take contraception alongside HRT, and you should continue to use it until the age of 55. 

Myth #7: You should not start HRT too young

Most women start to experience menopause symptoms in their mid-to-late 40s7, but it can be earlier. It is important for women who experience early menopause or have had a hysterectomy to consider HRT. Younger women will be more at risk of osteoporosis because their ovaries are not making enough oestrogen and HRT can help to top up these hormones. 

Myth #8: You can only take HRT for 5 years

HRT can be taken for as long as the benefits outweigh any risks, which means many women happily take it for more than five years. 

Younger women on HRT should not stop before the age of 50, to protect themselves from bone loss8

Myth #9: You need a thorough examination to ensure you are suitable for HRT

You can usually begin HRT as soon as you start experiencing menopausal symptoms if you are over the age of 45 without the need for any tests. A blood test may be carried out if you are aged 40-45, or used to diagnose premature menopause in people under 409.

Myth #10: If you’re taking HRT, you no longer need contraception

HRT isn’t a contraceptive, unless you use the Mirena coil. You can take contraception alongside HRT, and you should continue to use it until the age of 55. 

References

References