Is Hormone Replacement Therapy Safe During Menopause? What Women Should Know
Author: Affiang Queen Uduak, MBBS
Medical Reviewer: Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)
Highlights
- Menopause is a natural phase of a woman’s life.
- Every woman experiences menopause differently.
- Hormone replacement therapy has benefits and risks.
- Hormone replacement therapy should be personalised.
- Hormone replacement therapy is used during menopause to alleviate some of the troubling symptoms that come with menopause.
- Menopausal women can live an enjoyable life.
Introduction
Mrs Green is a 50-year-old woman who stopped having her period one year ago. She struggles to sleep at night and experiences episodes of intense heat, which she describes as “internal heat”, during both day and night. She is worried about her symptoms and has heard about menopause and hormone replacement therapy, but still does not understand it. Many women like Mrs Green have questions about menopause and hormone replacement therapy.
Menopause is when a woman experiences complete absence of menstruation for twelve (12) consecutive months without any other obvious medical cause. It is a natural phase of life and marks the end of menstruation and natural conception.
Menopause usually occurs between 45 and 55 years for women worldwide, with an average of 51 years in the United States [1,2]. Menopause occurring between 40 and 45 years is early menopause, while menopause before 40 is premature menopause.
Before menopause, women go through perimenopause. This is a transition phase into menopause, during which menstruation becomes irregular and menopause-like symptoms may occur. Perimenopause usually begins in the 40s, although it varies from woman to woman.
As you approach menopause, ovulation becomes less frequent and certain hormones produced by your ovaries, particularly estrogen, begin to fluctuate before they start to gradually decline.
This decline in estrogen can cause some symptoms, and these symptoms differ from woman to woman. Some women have very few symptoms with less severity, while others have severe symptoms that affect their daily lives [1].
This article will help you understand the different hormone replacement therapy options, including their benefits and potential risks.
What Are the Symptoms of Menopause?
Menopause comes with symptoms. Some of these symptoms include:
- Hot flashes: this is a sudden feeling of intense heat on your face, neck and chest that can last for a few seconds to several minutes. Hot flashes happen any time during the day and at night.
- Night sweats: this is excessive sweating which happens while you are sleeping, soaking your clothes and bedding. Night sweats are usually as a result of hot flashes at night.
- Vaginal dryness: decreasing levels of estrogen may cause vaginal dryness and irritation, which can make sex uncomfortable.
- Sleep disturbance: when you have episodes of hot flashes and night sweats at night, you may find it difficult to fall asleep or wake up from your sleep because of the discomfort [2].
Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), is a treatment option used to reduce the severity of menopausal symptoms and help reduce bone loss and the risk of fracture that can happen in menopause. However, this treatment may not be suitable for every woman [3].
In this article, you will learn about what can make HRT unsuitable for you as a woman experiencing perimenopause or menopause.
What Is Hormone Replacement Therapy?
Hormone replacement therapy is a treatment process of artificially replacing female sex hormones, particularly estrogen, during perimenopause and menopause. The medications are similar to the hormones naturally produced in your body [2]. HRT is classified into two:
Based on the hormone composition:
- Estrogen-only therapy: This is given to women who no longer have a uterus (womb) as a result of a total hysterectomy [5].
- Combined hormonal therapy - Estrogen + progestogen: this is given to women who still have their uterus (womb) intact. The progesterone component helps reduce the risk of womb cancer [5].
Based on the routes:
- Systemic or whole-body therapy: with this therapy, estrogen is absorbed throughout the whole body. It is available in several forms, including:
- Skin patches
- Sprays
- Gels
- Pills
Systemic estrogen has been shown to relieve many symptoms of menopause.
- Low-dose vaginal estrogen: This therapy has a low dose of estrogen, and it is used particularly to treat vaginal and urinary symptoms of menopause. It is available in the following forms:
- Creams
- Vaginal rings
- Tablets (to be inserted into the vagina)
What Symptoms Can Hormone Replacement Therapy Help?
Menopause brings along with it symptoms that can affect a woman’s quality of life. The severity of these symptoms differs from woman to woman. HRT can help reduce some menopausal symptoms [2]. These symptoms include:
- Hot flashes
- Night sweats
- Vaginal dryness and irritation
- Recurrent urinary tract infections
What Are the Benefits of Hormone Therapy?
HRT remains the most effective treatment for relieving symptoms like hot flashes and night sweats. If you are otherwise healthy, starting the therapy before the age of 60 or within 10 years of menopause onset is more favourable, provided you have no medical reasons not to commence HRT [6].The benefits include:
- Relieving hot flashes and night sweats
- Relieving vaginal dryness and irritations (with low-dose vaginal estrogen)
- Reducing the risk of recurrent urinary tract infection (with low-dose vaginal estrogen)
- Reducing the risk of bone loss (osteoporosis) and fracture
- Improving sleep
What Side Effects Can Hormone Therapy Cause?
When you start HRT, you may experience mild side effects or none. However, if you do, it is expected that the side effects should stop after 3 months of commencing the therapy. Therefore, you should discuss with your doctor if any of these symptoms are severe or do not go away after 3 months of HRT:
- Headaches; these can be relieved with some pain medications.
- Nausea; taking the tablets with meals that are not spicy can help.
- Diarrhoea; speak with your doctor if this lasts longer than one week.
- Unexpected vaginal spotting/bleeding
- Temporary breast soreness
- Low mood or depression
What Are the Risks of Hormone Therapy?
While HRT has benefits, it also has potential risks [4]. These risks are dependent on:
- Your age
- Your personal health history
- Your current health status
- Presence or absence of your uterus
- Your family health history
- Type, dose, route, and duration of HRT
- Lifestyle factors e.g. smoking, obesity
The risks that can occur with HRT include:
- Endometrial (uterine) cancer: this can happen when your uterus is still intact, and you take estrogen-only HRT. The combined HRT reduces your risk of endometrial cancer because the progestogen protects your uterus. You should let your doctor know if you notice any of these symptoms of uterine cancer:
- Unscheduled vaginal bleeding
- Unusual vaginal discharge
- Pelvic pain
- Unintentional weight loss
Your doctor may require you to do some tests to exclude uterine cancer when experiencing unscheduled vaginal bleeding.
- Cardiovascular (heart) disease: the risk of having a heart disease is very low if you are under 60 years and have no medical history of any heart disease. Therefore, starting HRT 10 years after menopause and/or having a history of heart disease may increase your risk of heart disease [4,5].
- Venous Thromboembolism (VTE): oral HRT increases your risk of having blood clots in your veins, known as VTE. Other forms of HRT such as gels, sprays or patches lower this risk [4,5]. Signs that you may be having VTE include:
- Unexplained swelling, pain, warmth or redness in one leg.
- Sudden shortness of breath
- Chest pain, especially pain that worsens with breathing
- Coughing up blood
You should seek urgent medical attention if you notice any of these signs.
- Stroke: the risk of having a stroke while on HRT may increase with the following:
- Age greater than 60
- Oral HRT
- A high dose of estrogen
- A history of a cardiovascular disease
Seek emergency care immediately if you develop:
- Sudden weakness or numbness on one side of your body
- Sudden difficulty speaking or understanding speech
- Sudden vision problems
- Sudden severe dizziness or loss of balance
- Sudden severe headache with no obvious cause.
- Breast cancer: this is usually a long-term risk. The risk of breast cancer may increase after about 5 years of combination therapy or 7 years of estrogen-only therapy. You should watch out for any of these signs and inform your doctor:
- A lump in your breast;
- A lump in your armpit;
- Any changes in the skin, size or shape of your breast
- Any change in your nipple
- Any unusual nipple discharge
- Ovarian cancer: if you commence HRT under 60 years of age and have no history of ovarian cancer in the past, the risk of having ovarian cancer is very low. However, this risk may increase slightly after 5 years of using any form of estrogen-only HRT [4].
- Gallbladder disease: the risk of gallbladder disease associated with oral HRT is very low [7].
Share your concerns about these risks with your doctor. Let your doctor know about your complete personal and family history. Together, you will determine if the therapy is an option for you and how it can be tailored to suit you where possible.
Who May Not Be a Good Candidate for Hormone Therapy?
Hormone therapy, particularly whole-body therapy may not be suitable for every woman. You may not be a good candidate for hormone therapy if you have:
- Unexplained vaginal bleeding after menopause
- Previous or current venous thromboembolism
- Previous or current stroke or cardiovascular disease
- Previous or current breast cancer or other estrogen-sensitive cancers
- Significant liver disease
Conclusion
The safety of HRT is variable and dependent on factors such as your age, symptoms, formulation, route, uterus status, medical history and risk factors. Therefore, this therapy must be individualised to reduce the risks of HRT.
Menopause should not prevent you from living an enjoyable life. If you are experiencing menopausal symptoms, speak with your doctor about your treatment options. Together, you can weigh the potential benefits and risks and choose an approach that is appropriate for you.
Frequently Asked Questions (FAQs)
When Do I Stop Taking HRT?
There is no fixed time when every woman should stop hormone therapy. Your doctor will periodically review your symptoms, health, individual risks and benefits to determine whether continuing treatment is appropriate. If symptoms return after stopping, discuss this with your doctor.
Can Other Medications Help With Menopause?
Other medications like antidepressants and selective estrogen receptor modulators (SERMs) have been shown to help reduce some of these symptoms.
Can Herbal Medications Help With Menopause?
Some herbs have been used for relief of menopause symptoms. However, only a few of these substances can be considered safe and effective based on studies.
Is Vaginal Bleeding Normal While Taking HRT?
Unscheduled bleeding can occur after starting or changing HRT. However, persistent or heavy vaginal bleeding is not normal, and you should tell your doctor about it.
Can I Use HRT as Contraception?
HRT does not prevent pregnancy because of the low dose. Therefore, women in perimenopause can still become pregnant despite having menopause-like symptoms.
References
Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition
Published September 22, 2026