HRT, Managing Symptoms, Menopause Advice, Perimenopause
The Confusion Around HRT
For years, hormone replacement therapy (HRT) has been surrounded by confusion, fear, and misinformation. Women experiencing hot flushes, brain fog, joint pain, and mood swings often wonder:
Is HRT safe? Does it cause cancer? Will it help with weight gain and brain fog? What are the risks versus the benefits?
With conflicting headlines and outdated medical advice, many women are left struggling through menopause symptoms without proper guidance.
As a menopause specialist, I want to clear up the myths, explain the science, and give you the latest research so you can make an informed decision about HRT.
What is HRT? A Simple Breakdown
HRT (Hormone Replacement Therapy) replaces the hormones that naturally decline during menopause—primarily oestrogen and, in some cases, progesterone and testosterone.
Oestrogen – The key hormone that helps relieve hot flushes, brain fog, joint pain, mood swings, and vaginal dryness. Progesterone – Given to women who still have a uterus to protect against endometrial (womb) cancer. Testosterone – Sometimes prescribed to boost libido, brain function, and energy in menopausal women.
Fact: The body still needs oestrogen after menopause to protect the brain, bones, and heart.
Myth vs. Fact: Debunking Common HRT Misconceptions
Myth 1: HRT Causes Breast Cancer
Fact: The link between HRT and breast cancer has been exaggerated and misunderstood.
The Science: The 2002 Women’s Health Initiative (WHI) study caused fear around HRT, but later analysis showed:
Oestrogen-only HRT (for women without a uterus) does NOT increase breast cancer risk.
The small risk linked to combined HRT (oestrogen + progesterone) is the same as drinking 1 glass of wine per day.
The absolute risk increase is minimal (4 additional case per 1,000 women per year).
Takeaway: HRT is not the primary cause of breast cancer, and the benefits often outweigh the risks for most women.
Myth 2: HRT Increases the Risk of Heart Disease
Fact: Oestrogen actually protects the heart—when taken early in menopause.
The Science:
Women who start HRT before the age of 60 or within 10 years of menopause have a lower risk of heart disease.
HRT helps maintain healthy cholesterol levels and reduces inflammation in the arteries.
The British Heart Foundation recognises oestrogen’s protective effects on cardiovascular health.
Takeaway: HRT can reduce heart disease risk if started at the right time.
Myth 3: HRT Causes Weight Gain
Fact: HRT does NOT cause weight gain—in fact, it may help prevent midlife weight gain.
The Science:
Oestrogen supports metabolism and prevents fat accumulation around the abdomen.
Muscle mass declines without oestrogen, making weight gain more likely in women who don’t take HRT.
Women often gain weight due to aging and lifestyle changes, not HRT itself.
Takeaway: Staying active and eating a balanced diet will support weight management—HRT can help by maintaining muscle and metabolic health.
Myth 4: HRT Only Helps with Hot Flushes
Fact: HRT benefits almost every system in the body, not just thermoregulation.
HRT’s Benefits Beyond Hot Flushes:
Brain Health: Reduces brain fog and lowers dementia risk in early menopause. Bone Health: Prevents osteoporosis by reducing bone loss. Heart Protection: Helps maintain arterial flexibility and circulation. Mental Health: Supports mood stability and anxiety reduction. Skin & Hair: Improves collagen production, reducing wrinkles and hair thinning.
Takeaway: HRT is a full-body support system, not just a fix for hot flushes.
The Latest Research: What We Know in 2024
HRT research has come a long way, and today’s approach is personalised and safer than ever.
1. The "Window of Opportunity" for Maximum Benefit
Starting HRT early (within 10 years of menopause) has the best protective effects on the brain, heart, and bones.
Delaying HRT past 60 doesn’t mean it’s unsafe, but benefits may be lower.
What This Means: If you're struggling with menopause symptoms, don’t wait—early treatment provides the best long-term health benefits.
Body-Identical vs. Synthetic HRT: What’s the Difference?
Body-Identical HRT (Recommended in the UK) – Derived from plant-based sources and chemically identical to natural hormones. Examples:
Oestrogen gel (e.g., Oestrogel) Oestrogen patches (e.g., Evorel) Micronised progesterone (Utrogestan)
Synthetic HRT (Older Formulations) – Used in the past but linked to higher risks of side effects.
The NHS and the British Menopause Society now recommend body-identical HRT as the safest option.
Can HRT Reduce Dementia Risk?
Recent research suggests that oestrogen plays a major role in brain health, reducing Alzheimer’s risk in women who start HRT early.
The Science:
A Lancet Neurology study found that women who take HRT have better cognitive function.
Oestrogen supports brain plasticity, reducing the risk of memory loss.
Takeaway: More research is ongoing, but HRT could be a powerful tool for brain health in midlife women.
Who Should NOT Take HRT?
While HRT is safe for most women, it may not be suitable if you have:
A history of breast cancer or oestrogen-sensitive cancers or a very strong family history or any BRACA genes. Uncontrolled high blood pressure (needs to be managed first) Severe liver disease or rare blood clotting disorders If you’re unsure, consult a menopause specialist to discuss personalised options.
Final Thoughts: Is HRT Right for You?
HRT is one of the most effective treatments for menopause symptoms and offers long-term health benefits, but the choice is personal.
If you’re struggling with hot flushes, brain fog, low energy, or mood swings, HRT could be life changing. The latest research confirms its safety when started early. If you can’t take HRT, lifestyle strategies (strength training, diet, stress management) remain crucial for menopause health.
Next Step: Speak to a BMS (British Menopause Society) Specialist for personalised menopause care.