Hormone Replacement Therapy (HRT) can be highly effective in alleviating menopausal symptoms that can have a profound impact on women’s lives, including work, relationships, mental health, and overall well-being. Many women experience significant symptom relief and regain their sense of normalcy once they find the right HRT regimen for them.

Moreover, there are important long-term health benefits of HRT that deserve more attention:

• Heart Benefits: HRT, when initiated within 10 years of the last period or before age 60, can significantly reduce the risk of cardiovascular disease in women. This helps mitigate the increased risk of heart issues that often comes after menopause.

• Bone Benefits: Women start losing bone density in their late 30s, and this accelerates during and after menopause. HRT can help reduce the risk of osteoporosis and fractures, particularly if initiated under the age of 60.

When to Stop HRT:

The NICE guidelines state that women can continue HRT for as long as the benefits outweigh the risks. This means that, for many women, it can be safely continued into old age, especially if transdermal estrogen is used and annual reviews assess the individual benefit-to-risk ratio. Gradually reducing the estrogen dose as women age can still protect bone health.

Risks of HRT:

There are several myths and misconceptions about HRT that need to be addressed:

• Weight Gain: HRT does not necessarily lead to weight gain.

• Migraines and Blood Clots: Not everyone with migraines or a family history of blood clots is excluded from HRT.  Transdermal HRT (patches/ gels/ sprays) are an option with a progesterone that does not have an increased clotting risk like Utrogestan.

• Delaying Menopause: HRT does not merely postpone menopause; it addresses its symptoms and long-term health effects.

• Duration: It is not always necessary to use HRT for the shortest possible time.

The concern about breast cancer risk has been overstated in the past. Recent research indicates that women who take estrogen-only HRT for over 20 years have little to no increased risk of developing or dying from breast cancer. The small increased risk associated with estrogen and synthetic progestogen HRT does not apply to women with POI or early menopause and does not increase until their early 50s. Body-identical micronized progesterone (Utrogestan) carries even lower breast cancer risk.

While there is a small increased risk of blood clots and strokes with oral estrogen forms, this risk is not associated with transdermal estrogen (patch, gel, or spray). Capsules of body-identical progesterone are the safest progestogen for those at risk of blood clots.

In summary, HRT offers significant quality-of-life improvements by reducing menopausal symptoms and providing long-term benefits for heart and bone health. Current evidence indicates that overall mortality is lower in women using HRT compared to those who do not, underscoring its importance.