The vast majority of my patients who I've seen in the general practice setting with menopausal symptoms are very definite that they do not want to take HRT. They tell me that they would prefer to take the “natural route” and they “do not want to meddle with nature” or, most commonly, that “HRT causes breast cancer”.
What they often do not understand is that for the vast majority of women under the age of 60, the benefits of HRT outweigh any risks. There are numerous studies and guidelines which support this statement. I hope this article will dispel some of the popular myths regarding HRT.
MYTH: You have to wait for your symptoms to be really bad or even unbearable before your doctor can give you HRT
Many women delay going to their doctor and asking for treatment as they feel that they are wasting their doctor’s time and they should wait until their symptoms are really bad. This is not the case as HRT will help even if you have mild symptoms. In addition, there is increasing evidence that the earlier HRT is started, the more you will get protection from osteoporosis and heart disease.
MYTH: HRT delays the menopause
Many women avoid taking HRT as they think that when they stop taking it they will then have their menopause then. Any symptoms you might experience after stopping HRT are menopausal symptoms you would have experienced even if you had never taken HRT. [A caveat here is that you may experience oestrogen “withdrawal” symptoms if you suddenly stop your HRT without speaking to your doctor (it is best to reduce your dose and come off slowly). However, these are temporary and – if they occur – should only last for a couple of weeks at the very most.] Without HRT, many women have menopausal symptoms for more than a decade and some women still have hot flushes when they are over 75 years old.
MYTH: You have to stop HRT after 5 years
Many doctors try and encourage women to stop taking HRT after five years. However, there is actually no good scientific reason for this. Each woman needs to be assessed individually for the time they need to take HRT for. The length of time you take HRT for is an individual choice and depends on your individual risks and benefits. If you are under 51 years of age then you need to take HRT until you are at least 51 years, regardless of the age you are when you start taking it. There is no specific age at which you need to stop taking HRT. I have some patients in their 80s who still take HRT.
MYTH: There is an increased risk of breast cancer with all types of HRT
This is the risk that most women worry about with HRT. You may have a small increased risk of breast cancer if you take some types of HRT. However, if you are taking oestrogen only HRT (so, if you have had a hysterectomy) then do not have an increased risk of breast cancer. There are many risk factors for developing breast cancer. Women who are overweight, drink alcohol, smoke, undertake little or no exercise all have a higher risk of developing breast cancer. The increased risk of breast cancer is associated with women who take certain types of combined HRT (oestrogen and a progestogen) and this risk increases the longer you take HRT for. This risk appears to be lower with some types of progestogens compared to others. When you stop taking HRT, any increased risk of breast cancer reduces.
The actual risk of breast cancer with taking combined HRT is very small. The risk is actually less than the risk of breast cancer in women who are obese and in those women who drink two to three units of alcohol each day. There is no evidence that taking HRT increases a woman’s risk of dying from breast cancer.
Note: There is no increased risk of breast cancer in women who take HRT under the age of 51 years (see later myth).
MYTH (for some types of HRT): HRT causes clots
If you take oral (tablet) HRT then there is a small increased risk of a clot developing in your leg or lungs. This increased risk is very small and is higher if you have other risk factors for developing a clot such as obesity or a having a history of a clot in the past.
However, if you take the oestrogen part of HRT as either a gel or a patch then it gets absorbed directly into your body which means that the clotting factors in your liver are not activated (which they are when you swallow a tablet) and then this is not associated with an increased risk of clot.
MYTH: HRT will cause heart attacks and strokes
Taking HRT when you are under 60 years of age does not actually increase your risk of developing a heart attack. Those women who only need to take oestrogen (without a progestogen) actually have a lower risk of heart disease compared to women who do not take HRT. There is a very small increased risk of stroke in women who take combined HRT but this risk is reduced by using the oestrogen as gels or patches. The risk of stroke in women under 60 years is very low, however, regardless of whether or not you take HRT.
MYTH: You can not take HRT if you have a migraine
Many women notice that their migraines worsen as they go through their menopause. As you cannot take the oral contraceptive pill if you have a history of migraines, many women (and doctors) incorrectly think that you cannot take HRT if you have migraines. If you have migraines, then you should take oestrogen as gels or patches rather than as tablets.
MYTH: HRT is associated with a risk of breast cancer in younger women with Premature Ovarian Insufficiency (POI).
POI is when the menopause occurs in women under the age of 40 years. Women with POI should be given replacement hormones either in the form of hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP) until at least the average age of the menopause (51 years). This is not just to improve any symptoms of the menopause but also to maintain their long-term health and reduce their increased risk of osteoporosis, cardiovascular, psychological and cognitive diseases. Any risks of HRT (for example, breast cancer risk) do not apply to younger women with POI taking HRT. Taking hormones is simply replacing hormones that your body would otherwise be making up until the age of the natural menopause.
MYTH: Using oestrogen vaginally for vaginal dryness is associated with the same risks as taking HRT
Vaginal dryness is very common and using topical oestrogen as a vaginal tablet, cream or ring can be really effective. Using topical oestrogen in this way is not the same as taking HRT and therefore does not have the same risks associated with it. This is because these preparations work to restore oestrogen to your vagina and surrounding tissues without giving oestrogen to your whole body. These preparations can be safely used by most women and also can be used on a regular basis over a long period of time (usually indefinitely) as your symptoms will usually return if you stop this treatment.
MYTH: Natural treatments for the menopause are always safer than HRT
Many women want to take “natural” products for their menopause but you have to be very careful how you define “natural”. The definition of “natural” can be misleading and confusing. There are many medicines available which are derived from plants so therefore they are “natural” but many are unsafe and have been shown to be harmful to our bodies.
Many of the hormones in HRT prescribed today are “body identical” which means they have the same molecular structure as the hormones in our bodies. They are also natural in that they are derived from a plant chemical which is extracted from yams, which are tropical root vegetables.
Last updated: November 2019