Venous thromboembolism (blood clotting): Oral HRT (combined oestrogen and progesterone or oestrogen only) increases the risk of venous thrombo-embolism (venous blood clots), pulmonary embolism (blood clot in lungs) and stroke.
HRT can slightly increase the risk of breast cancer. If you've had breast cancer you'll usually be advised not to take HRT. The increased risk is low: there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years.
Endometrial (womb) cancer: oestrogen-only HRT increases the risk of womb cancer. This increased risk gets bigger the longer HRT is used, and may stay for some years after HRT is stopped. This is why it is usually only prescribed to people who are not at risk of womb cancer.
Hormone therapy can help ease symptoms of menopause. But it is associated with a lot of serious risks if used over the long term. Although the treatment lowers the risk of bone fractures, it increases the risk of cardiovascular disease (heart and blood vessel problems) and breast cancer.
Long-running studies
Over the last 15 years, these studies, and others, have found little or no evidence that HRT reduces the risk of heart disease. In fact, they have found evidence for an increased risk of blood clots and stroke. They also found an increased risk of breast and ovarian cancer in women using HRT.
All women taking HRT should have an annual review with their doctor or nurse. If you continue to be healthy and feel the benefits of taking HRT, there is no reason for stopping it. Women are often surprised when their menopausal symptoms return after coming off HRT, even those women that have taken it for many years.
One alternative that is now generating substantial interest is phytoestrogens and in particular a group called isoflavones. These are compounds found in foods that can behave in a similar way to oestrogen in the body.
In addition to increasing longevity, hormone replacement therapy can help to address many of the changes we experience as we grow older. Estrogen therapy is associated with healthier and younger-looking skin in women.
Managing menopause symptoms without HRT
Cutting back on alcohol, caffeine, and spicy foods, and quitting smoking, can minimize your hot flashes. Exercising regularly can reduce your risk of weight gain, as well as symptoms of hot flashes and disrupted sleep.
HRT is also known to help women maintain softer, smoother skin, resulting in a younger look. In addition to—and, often, as a result of—these physical changes, HRT often changes how you see yourself. In very real ways, using HRT to address symptoms of hormonal change can help you feel younger.
So in summary, the safest types of HRT are the oestrogen applied through the skin as a patch, gel or spray with body identical micronised progesterone. Many women also benefit from testosterone, which may help if you're forgetful or having trouble concentrating at work.
Dr Newson says “Many women are concerned that they will put on weight when they begin taking HRT. However, having oestrogen through the skin as a gel or patch with micronised progesterone does not usually lead to weight gain.
Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.
It also provides long-term health benefits for many women and reduces the risk of osteoporosis, fractures, and heart disease. If HRT is started before the age of 60, or within ten years of the menopause transition, it reduces the number of early deaths in women.
HRT has more benefits than risks in the majority of women when started as early as possible and ideally before the age of 60 years however, this does not mean that it cannot be started after the age of 60.
If you have premature menopause (before the age of 40) or early menopause (before the age of 45), it's particularly important to take either HRT or the combined pill. This increases your level of oestrogen, which helps protect you from conditions such as osteoporosis.
Magnesium typically decreases along with estrogen in menopause, making symptoms associated with low magnesium levels more noticeable. Magnesium supplements can benefit people in menopause, but be sure to talk to your healthcare provider before taking any new supplements.
Genes associated with follicle growth were not significantly altered by vitamin D3. However, it increases expression of genes involved in the estrogen-biosynthesis. Further, estrogen concentrations in porcine granulosa cell-cultured media increased in response to vitamin D3.
While you may start feeling a difference within a few days or weeks, it usually takes longer for HRT to achieve its full effects. Three to six months is a reasonable trial period for systemic HRT, which includes pills, patches, sprays and gels. If you haven't seen an improvement by this point, speak to your doctor.
If you are healthy, most experts agree that HRT is safe to use at the lowest dose that helps for the shortest time needed. If you're 59 or older, or have been on hormones for 5 years, you should talk to your doctor about quitting.
Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks. Type of hormone therapy.