Hormone Replacement Therapy – Benefits, Risks and Uses
Hormone Replacement Therapy (HRT) replenishes hormones that decline during menopause, relieving symptoms such as hot flashes, sleep disturbances, and mood changes.
Things worth knowing about "Hormone Replacement Therapy"
Hormone Replacement Therapy (HRT) replenishes hormones that decline during menopause, relieving symptoms such as hot flashes, sleep disturbances, and mood changes.
What is Hormone Replacement Therapy?
Hormone Replacement Therapy (HRT) is a medical treatment that supplements hormones the body no longer produces in sufficient quantities. It is most commonly prescribed for women experiencing menopause, when the natural production of oestrogen and progesterone declines significantly. HRT may also be used after surgical removal of the ovaries, in cases of premature ovarian insufficiency, or as part of gender-affirming care for transgender individuals.
Indications and Uses
HRT is used in a variety of clinical situations, including:
- Menopausal symptoms: Reducing hot flashes, night sweats, sleep problems, vaginal dryness, and mood disturbances
- Surgical menopause: Following bilateral oophorectomy (removal of both ovaries)
- Premature ovarian insufficiency: In women under 40 whose ovaries stop functioning normally
- Osteoporosis prevention: Protecting bone density that declines due to oestrogen deficiency
- Gender-affirming hormone therapy: As part of transgender healthcare
Mechanism of Action
The hormones used in HRT — typically oestrogen alone or in combination with progestogen — bind to specific hormone receptors throughout the body. Oestrogen plays a key role in regulating bone metabolism, maintaining the health of mucous membranes, and supporting cardiovascular function. Women who still have a uterus must receive combined therapy (oestrogen plus progestogen), as oestrogen alone can cause abnormal thickening of the uterine lining. Women who have had a hysterectomy may receive oestrogen-only therapy.
Forms of Administration
HRT is available in several forms to suit individual needs and preferences:
- Oral tablets: Convenient but subject to first-pass liver metabolism
- Transdermal patches: Deliver hormones steadily through the skin, with lower liver impact
- Gels and sprays: Applied to the skin for flexible dosing
- Vaginal preparations (rings, creams, pessaries): Used locally for vaginal dryness and urogenital symptoms
- Injections and implants: Less common, used for specific clinical indications
Benefits and Risks
Benefits
- Significant relief from menopausal symptoms and improved quality of life
- Prevention of osteoporosis and related fractures
- Improved skin hydration and mucosal health
- Possible cardiovascular benefit when therapy is initiated early in menopause
Risks and Side Effects
- Breast cancer: Long-term combined HRT may slightly increase breast cancer risk; this risk decreases after stopping treatment
- Thromboembolism: Increased risk of blood clots, particularly with oral formulations; transdermal routes carry lower risk
- Stroke: Slightly elevated risk, mainly associated with oral oestrogen use
- Endometrial cancer: Risk increases with unopposed oestrogen in women with an intact uterus
- Common side effects include breast tenderness, nausea, headaches, mood changes, and irregular bleeding
Diagnosis and Treatment Planning
Before starting HRT, a thorough medical history and physical examination are performed. Blood tests measuring hormone levels — such as FSH, LH, and oestradiol — can confirm hormonal deficiency. Individual risk factors including family history, existing medical conditions, and lifestyle factors are carefully considered to tailor the treatment plan. The guiding principle is to use the lowest effective dose for the shortest necessary duration. Follow-up appointments every 6 to 12 months are recommended to monitor response and safety.
Contraindications
HRT is not suitable for everyone. Key contraindications include:
- Known or suspected breast cancer or other oestrogen-dependent tumours
- Unexplained vaginal bleeding
- Current or previous deep vein thrombosis or pulmonary embolism
- Severe liver disease
- Pregnancy
References
- Stuenkel CA et al. – Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2015; 100(11): 3975–4011.
- National Institute for Health and Care Excellence (NICE) – Menopause: diagnosis and management. NICE Guideline NG23, 2015 (updated 2019). Available at: www.nice.org.uk
- World Health Organization (WHO) – Research on the Menopause in the 1990s. WHO Technical Report Series, Geneva.
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