Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) is a treatment that reduces menopause symptoms by changing hormone levels in the body.
Menopause is when the ovaries produce less estrogen, which is a female reproductive hormone. Decreased estrogen levels lead to symptoms of menopause like hot flashes, vaginal dryness, and mood changes. These symptoms can cause discomfort.
Hormone replacement therapy helps to reduce these symptoms by improving estrogen levels in your body. There are many types of hormone replacement therapy. It can be given in the form of oral tablets, injections in the skin, patches, gels, creams, or long-lasting implants. It can also be given through the vagina by applying a cream or inserting a device called a pessary.
Estrogen is usually given for hormone replacement therapy. This is called estrogen-only HRT. But sometimes estrogen and progestogen may be given in combination, which is called combined HRT. Progestogen is a synthetic form of the female reproductive hormone progesterone.
This treatment has benefits. But there can be disadvantages to hormone replacement therapy. These disadvantages may include the risks associated with the procedure and the side effects caused by the hormones.
Hormone replacement therapy disadvantages
Here are some side effects that result from estrogen and progestogen HRT.
Side effects of estrogen
If you’re given estrogen-only HRT, you may experience the following side effects of the hormone estrogen:
- Tenderness or swelling in body parts like the breasts
- Leg cramps
- Stomach problems like indigestion
- Vaginal bleeding
These symptoms may make you feel sick and cause discomfort. They usually go away after a few weeks.
You can ease the side effects by following these steps. If you’re taking estrogen tablets, have them with food to prevent indigestion. Opt for a low-fat, high-carbohydrate diet, which can help reduce breast tenderness. Regular exercise or stretching can help prevent leg cramps.
Side effects of progestogen
Progestogen is generally given in combination with estrogen for HRT. It has the following side effects:
- Breast tenderness and swelling in the body
- Headaches or migraines
- Back pain
- Mood swings
- Abdominal pain
- Vaginal bleeding
Typically, these side effects improve over time. If you have serious side effects that remain for over 3 months, talk to your doctor to change the form or dose of the hormone.
Hormone replacement therapy risks
Hormone replacement therapy risks mainly depend on the type or form of HRT, the age at which it’s taken, how long it’s taken for, and other underlying conditions. The risks and benefits of HRT vary from person to person based on these factors.
1. Blood clots
Hormone replacement therapy tablets are associated with a risk of blood clots in the veins. Some underlying conditions, such as a family history of clotting or obesity, can put you at a high risk of blood clots. In such cases, your doctor may give you HRT patches or gels instead of tablets.
2. Heart disease and stroke
If you’re over 60 years old, having HRT tablets can increase your risk of stroke and heart disease. The risk of developing these conditions is very low if you’re below 60 years of age.
If you're already at risk of heart disease, your doctor may prescribe HRT patches or gels. These forms of HRT are not associated with the risk of stroke or heart problems.
Studies show that estrogen-only HRT doesn’t affect the risk of developing breast cancer. But combined HRT with estrogen and progestogen may increase the risk of breast cancer.
If you take estrogen and progestogen HRT for a long time, it can further increase breast cancer risk. However, the risk decreases once you stop taking HRT.
Because of this risk, it’s important to go for breast cancer screenings if you're on HRT.
Both estrogen-only and combined HRT can increase your risk of developing ovarian cancer. Once HRT is done, your risk decreases back to its normal level.
5. Womb or uterine cancer
Estrogen-only HRT increases womb or uterine cancer risk. If your treatment goes on for a long period of time, the risk may increase.
To eliminate the risk of womb cancer, estrogen-only HRT is usually given to women with a hysterectomy. A hysterectomy is a procedure in which a person has their womb or uterus removed.
Combined HRT is not associated with womb cancer risk, but it may increase the risk of breast cancer.
To avoid hormone replacement therapy risks, talk to your doctor about the best treatment option for you.
Avoid smoking, limit alcohol, and maintain a healthy weight to decrease your risk of cancer.
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Cancer Research UK: “Does hormone replacement therapy (HRT) increase cancer risk?”
NHS: “Benefits and risks,” “Side effects,” “Types.”
NICE: “Benefits and risks of HRT.”
Women’s Health Concerns: “HRT: Benefits and risks.”
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