Hormone Replacement Therapy

HRT comes in a dazzling array of creams, pessaries, gels, implants, and tablets. It’s the medical approach to dealing with menopause.

What is HRT?

When you go through menopause, your body stops producing the hormones estrogen and progesterone. Quite simply, hormone replacement therapy (HRT) puts these hormones back into your system.

When it first appeared in the 1930s, HRT was called “estrogen replacement therapy”. The medication was hailed as a wonder drug, an anti-aging miracle that could abolish menopause and keep women “feminine forever”. However, in time, research confirmed that giving estrogen on its own increased a woman’s risk of developing breast and uterine cancer. Estrogen is a “builder”, creating a thick uterus lining that’s ready to receive an embryo. In the second half of your cycle, your body produces progesterone so that at the end of the cycle, the uterus lining sheds away and the cycle begins again. Taking estrogen without the balance of progesterone (or progestin, the synthetic form of the hormone), means that the uterus lining can continue to thicken, become abnormal, and lead to uterine cancer. Similarly, a continuous intake of estrogen stimulates breast tissue, again casing cancer.

With this realization, panic set in. Scientists knew that they had to add progestin into the hormone replacement medication in order to make it safer. And that’s exactly what they did.

Natural vs synthetic

You may have heard some of the estrogen used in HRT described as “natural”. In this case, the work natural means that the estrogens (there are many different kinds) are chemically identical to the hormones produced by your ovaries – but they are still artificial. The “natural” estrogen contained in most HRT is estradiol, considered the most carcinogenic form of synthetic estrogen available. In the USA, special “compounding” pharmacies will make up dosages of HRT according to a doctor’s specific instructions, in which case many doctors instruct that the pharmacy use estriol rather than estradiol; while in the UK, doctors may prescribe HRT containing less carcinogenic estriol (the ingredients on the packet will tell you).

The side-effects of HRT

It’s easy to imagine that because HRT is simply doing a job your body once did, the medication won’t have any side-effects. Unfortunately, HRT can have all sorts of unwanted effects on your system. How many you get and how debilitating they are is unique to each woman. However, overall, around 35 percent of women stop taking HRT because of the unwanted effects.

The most common symptoms that women report to the doctors are breast tenderness and enlargement (up to two cup sizes). This is particularly alarming. It seems that if HRT stimulates breast tissue, it may pose a greater risk of breast cancer. If breast changes happen to you, please see your doctor immediately. Other noticeable side-effects are bloating, skin rashes, hair loss, abdominal cramps, and vaginal yeast infections. There are other conditions you may not automatically assume are to do with your HRT but which we know are side-effects of the treatment. These include high blood pressure and thrombophlebitis (vein inflammation caused by a blood clot). Taking HRT for five years doubles your risk of having a blood clot.

Many women are concerned that HRT is making them put on weight. Although research concludes that there’s no link between HRT and weight gain, experiences suggest the opposite. Other women are concerned about the effect HRT can has on their psychological health. Some have described feeling of being “disconnected” or “not there”, as if they’re watching their lives rather than living them. In some rare cases, these women can become suicidal.

The following are the most serious effects of HRT. This is not to alarm you but to make an informed decision about whether or not you use this form of treatment. The wonder drug of the 1930s, it seems, may have some serious consequences.


Many of women come to their doctors with breast cancer at the top of their list of concerns. In 2002, the Women’s Health Initiative abandoned their study of 27,000 women after five years instead of eight: It had become clear that the study was putting women on HRT a 26-percent increased risk of breast cancer. Following the publication of the Health Initiative results in 2002, many women were scared off taking HRT: Researchers then looked at overall breast-cancer rates for 2003 and found that the rate of breast cancer had dropped by 12 percent among 50-69-year-old women – the largest single droop in breast cancer cases in one year. This compounds the link between breast cancer and HRT.

You should have a breast ultrasound before your consider taking HRT. If the scan indicates that you have any abnormal changes in your breast tissue, avoid HRT. Whereas in natural circumstances these abnormal cells may never have caused a major problem, HRT may act as a catalyst for the cells to multiply, causing cysts or tumors.

You should also bear in mind that the link between HRT and breast cancer is there from the start – it doesn’t take several years of cumulative HRT use to become a problem. The good news is that when you stop taking HRT the risk goes down rapidly.

Finally HRT may make you more prone to uterine and ovarian cancer, especially if these cancers run in your family – heredity is an important factor when assessing your risk.

Blood clots

As well as the cancer dangers, HRT increases your risk of developing a blood clot, which can lead to a stroke, heart attack, or deep vein thrombosis (DVT; where the clot forms in your lower leg). Studies show that taking HRT creates a 41 percent increased risk of strokes and a 29 percent increased risk of heart disease. If you’re taking HRT and intend to fly, the increased risk of DVT is a serious one, and you should talk to your doctor before you travel. If the clot moves from your leg, you can suffer a pulmonary embolism, which can be fatal. The simplest solution is to stop taking HRT just before you fly, and resume only once you’re back on the ground.

Gall-bladder problems

HRT tipples the risk of gall-bladder cancer. In addition, the longer you stay on HRT, the more likely you are to develop gallstones (and you’re more susceptible if you’ve had gallstones in the past)

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