Few treatments in women’s health have been as misunderstood as hormone replacement therapy (HRT). A flawed early-2000s study created two decades of fear that more recent, better-designed research has since walked back for most healthy women.
What HRT actually does
HRT replaces the oestrogen — and usually progesterone — that your body produces less consistently during perimenopause and menopause. For many women it meaningfully reduces hot flashes, night sweats, vaginal dryness, and can support bone density over the long term.
The benefits, in plain terms
- Significant relief from hot flashes and night sweats for most users
- Improved sleep quality as night sweats subside
- Protection against bone density loss
- Some evidence of cardiovascular benefit when started within ten years of menopause
The risks worth discussing
Risk profiles vary by age, time since menopause, family history, and the type and route of hormones used (oral versus transdermal, for example). For most healthy women under 60 who start HRT within ten years of menopause, the benefit-risk balance is generally favourable — but “generally” is not “universally,” which is exactly why this decision should be individualised.
Questions worth asking your doctor
- Am I a candidate based on my personal and family history?
- Would transdermal (patch/gel) or oral oestrogen suit me better?
- How will we monitor and reassess this over time?
HRT is not right for everyone, and it is not wrong for everyone either. The only way to know is an informed conversation with a clinician who treats this stage of life as the medical topic it is.