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The pros and cons of Hormone Replacement Therapy

Night sweats, insomnia and hot flushes – for around 80% of women the menopause brings a host of unwelcome symptoms. Is hormone-replacement therapy (HRT) the answer?

What are the benefits of HRT?

For many women, HRT can help relieve common symptoms that last on average around four years during and after the menopause – for example, hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive. HRT can also help prevent osteoporosis (weakening of the bones), which is more common after the menopause. Professor Hasib Ahmed, consultant gynaecologist at Benenden Hospital, says: “I find that HRT patches work particularly well. The hormones go straight through the skin and into the blood stream, and the patient receives a steady dose rather than the peaks and troughs that you can get with tablets. There are many different treatments and we endeavour to find one to suit the individual woman’s needs. There are tablets, patches, gels, intravaginal tablets and a hormone-containing coil, the Mirena.”

Are there any downsides?

HRT is not suitable for everyone. Women with a history of breast, ovarian or womb cancer, or a history of blood clots, liver disease or high blood pressure, may be recommended an alternative to HRT.

There are two main types of HRT: therapy that combines oestrogen and progesterone, which is the most common; and oestrogen-only therapy.

While oestrogen-only HRT does not carry the same increased risk of breast cancer and heart disease, it sharply increases the risk of womb cancer, so is only recommended to women who have undergone a hysterectomy. HRT can also cause side effects such as headaches, abdominal pain and vaginal bleeding, which some women prefer to avoid.

Why aren’t women seeking treatment?

Part of the issue might be the mixed messages about HRT in the media. In 2002, a study suggested links with an increased risk of breast cancer and stroke. However, updated analysis of the original data and subsequent studies have shown that when HRT is an appropriate treatment, and used in the correct setting, the increased risks of serious problems, such as blood clots and breast cancer, are small. In short, for most women, the benefits of HRT are generally felt to outweigh the risks.

What about natural approaches?

There are also non-pharmacological or natural ways to tackle the menopause, which some women say work for them. Soya products, such as tofu and soya milk, are rich in isoflavones, which are phytoestrogens. Phytoestrogens are plant-based foods that can have an oestrogen-like effect on the body. Red clover and black cohosh, available from health food shops, are also said to help, although to date there is no hard evidence to support this. There is also bio-identical HRT, which is tailored to a woman’s individual and precise needs, but robust scientific evidence is rather limited.


If you'd like some tips for tackling some of the unwanted symptoms of the menopause, read more here – although don’t be afraid to see your GP if you feel that things are becoming difficult to manage.