Dr Philippa Kaye: HRT Risks & Benefits

Shutterstock / Anna Nahabed © Outdoor portrait of beautiful 55 - 60 year old woman, wearing blue pullover

Dr Philippa Kaye gives us the low-down on whether HRT is worth considering…

Dr Philippa Kaye

Dr Philippa Kaye

At 49, Camille had been struggling for about two years and came to me at the end of her tether, saying she felt she was falling apart. Her periods stopped when she was 48 but she had not realised her numerous symptoms were symptoms of menopause.

Menopause symptoms

We went through a check list of menopause symptoms and, although the stresses of pandemic may have contributed to some of her symptoms, the hormone changes of perimenopause and menopause may also be involved. As she is over the age of 45 no blood tests were required for diagnosis – perimenopause can be diagnosed over the age of 45 on symptoms alone, and as she hadn’t had a period for over a year she had gone through the menopause.

Camille had heard stories about hormone replacement therapy (HRT) – friends had told her it causes breast cancer, or blood clots and that the menopause was natural and everyone just had to “get through it”. While menopause is indeed a natural process (unless it is induced with medication or surgery) that does not mean that you just have to struggle on. There are lots of treatment options available, including non-hormonal options if you prefer.

The benefits of HRT can be significant

For many women the symptoms of menopause are disabling and impact on their quality of life. HRT enables them to continue working, having relationships and functioning as they wish too! In the longer term HRT decreases risk of developing osteoporosis, and may also protect against osteoarthritis (wear and tear arthritis), colorectal cancer, eye conditions such as macular degeneration and cataracts, and potentially against cardiovascular disease. It may help improve muscle mass and strength which tend to decline with age.

Dr Philippa Kaye explains HRT Risks

HRT lettering on a wooden dice

Pic: Shutterstock

There are potential risks, but it’s important to note that for most these risks are small. The best known risk is breast cancer. In UK women between the ages of 50 and 59, 23 out of every 1,000 will develop breast cancer in the following five years. If combined HRT is taken this increases by 4 cases to 27 per 1,000.

However, let’s put that into context: smoking increases the risk by 3 cases per 1,000, drinking more than 2 units of alcohol per day by an extra 5 cases, obesity an extra 24 cases per 1,000.

For newer forms of HRT, oestrogen and micronised progesterone (the same type as made naturally by the body) there is no increased risk of breast cancer for the first five years.

There is an increased risk of womb cancer if you have a womb and take oestrogen only HRT, but in order to prevent this, if you have a womb you should always be prescribed both oestrogen and progesterone.

If the oestrogen component of HRT is taken orally there is a small increased risk of developing a venous thromboembolism – a blood clot. However, if it is taken through the skin – for example, in a patch or cream – then there is no increased risk of clots. At the end of our consultation, Camille wanted to have a think and come back to me with her decision. Whatever she chooses is her choice, but it is so important to be empowered with the correct information in order to do so!

What if I don’t want HRT?

There are still other treatment options available, including antidepressants (selective serotonin reuptake inhibitors like citalopram, and selective serotonin and noradrenaline reuptake inhibitors like venlafaxine) as well as antiseizure medications such as gabapentin and pregabalin.

Being offered these does not mean that your doctor thinks you have depression or epilepsy – these medications can be used in varying dosages for different conditions, including symptoms of perimenopause and menopause.

Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.

Article written on May 5, 2022; article reviewed and updated on June 4, 2024.

Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on Prolapse, When To Bother Your Doctor, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.

Allison Hay

I joined the "My Weekly" team thirteen years ago and, more recently, "The People's Friend". I love the variety of topics we cover both online and in the magazines. I manage the digital content for the brands, sharing features and information on the website, social media and in our digital newsletters.