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. The risk increases the longer you take it, and the older you are. It falls again after you stop taking it.
Not-so-good candidates for hormone replacement therapy
Smokers and those with a family history of blood clots aren't good candidates for HRT.
Hormone replacement therapy (HRT) slightly increases the risk of breast cancer, ovarian cancer, and sometimes womb cancer.
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.
The benefits of HRT usually outweigh the risks for most women. The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks. Speak to a GP if you're thinking about starting HRT or you're already taking it, and you're worried about any risks.
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.
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.
There are many different HRT options available. Generally, the best option is one which provides a balance of good symptom relief with the lowest possible risk. For most women this is an oestrogen patch, gel or spray. This should be taken with some form of progesterone if you still have your womb.
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.
HRT was associated with increased risk of faecal incontinence, fibroids, gallbladder disease and gallstones, hearing loss, joint swelling, rheumatoid arthritis, and urinary incontinence (68,69,97,112–116).
Based on results from the very large Women's Health Initiative studies, combination HRT increases breast cancer risk and this increase in risk lasted for more than 10 years after the women stopped taking HRT. Higher-dose combination HRT increases breast cancer risk more than lower-dose combination HRT.
Some women have side effects such as nausea, fluid retention, bloating, breast tenderness and swelling, and irregular bleeding. These often go away with time. MHT may not be suitable for you if you have or have had: breast cancer, endometrial cancer or other cancers that are dependent on hormones.
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.
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.
Patches may be a better option than tablets if you have difficulty swallowing tablets, or are likely to forget to take it. Using patches can also help to avoid some side effects of HRT, such as indigestion, and unlike tablets, they do not increase your risk of blood clots.
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.
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.
Without estrogen, you are at risk for weak bones later in life, which can lead to osteoporosis. ET lowers your risk by slowing bone thinning and increasing bone strength. If you are in your 20s, 30s, or 40s, you may want to use ET to avoid early menopause after oophorectomy.