HT is an effective and widely used treatment for menopause symptoms including hot flashes, sleep problems, and mood changes. Although there are a lot of myths and misunderstandings around the use of HT, one study estimated that about 9% of American women aged 45 – 80, or 8.3 million people, use HT. Learn more about the facts as we myth-bust some of the most common misconceptions about HT.
Does HT cause breast cancer?
A common concern is about the link between HT and breast cancer.
1 in 8 women in the US develops breast cancer over the course of their lifetime. This is known as the baseline or background risk. Your own personal breast cancer risk depends on several different factors. For example, your risk is higher if you are overweight, drink alcohol, or have a strong family history of breast cancer.
If you are at low risk, the benefits of HT are generally thought to outweigh the risks. If you are at higher risk, it is worth having a discussion with your healthcare provider about the best approach for you.
Estrogen-only HT and breast cancer risk
Estrogen-only HT (used if you have had your uterus removed) is associated with no change in your risk of breast cancer if used for up to seven years. Data is still being collected on use beyond seven years.
Combined HT and breast cancer risk
HT which contains both estrogen and progesterone does increase your risk. But how much?
If you took one thousand women in their 50s and monitored them for five years, 23 would be expected to develop breast cancer if they didn’t take any hormonal medications – the baseline risk. Based on the data from one large randomized trial, if that same thousand women were all taking combined HT (estrogen and progesterone), an extra four women would develop breast cancer.
This risk is less than the risk of moderate alcohol use or being overweight. To put this into context:
- Five extra cases would be diagnosed if all of the women drank one or more drinks per day
- 24 extra cases would be diagnosed if they were all overweight or obese
It is also worth noting that modern types of progesterone which are identical to those found in the body – micronized progesterone – are now thought to be lower risk than older, synthetic forms of the hormone.
Your risk returns to that of someone who has never taken HT within five years of stopping treatment.
Vaginal HT and breast cancer risk
Vaginal HT is widely used and comes with no additional breast cancer risk. This is because of the type of hormones used, and the fact that they are not absorbed into the bloodstream.
Read more about the different types of HT.
Does HT increase the risk of cardiovascular disease?
HT is not thought to cause any increase in your cardiovascular risk. If started before the age of 60 or within 10 years of your last period, it may reduce your risk and slow down atherosclerosis (the age-related narrowing of blood vessels).
Despite this, HT is only a small part of the story. Your cardiovascular risk depends on several factors including your blood pressure, family history, weight, smoking history, and other medical conditions. Your healthcare provider will be able to help you decide on the best way to protect and improve your cardiovascular health.
Does HT make you gain weight?
HT does not cause weight gain. In fact, it can reverse some of the changes in fat distribution that happen at menopause, when fat tends to accumulate around your waist.
It is, however, very common to see changes in your weight around this time – a gain of about one pound per year is normal in middle age. This is due to a combination of reasons, not all of which are related to your changing hormone levels.
Changes that contribute to weight gain include:
- Increased hunger
- Age-related decline in metabolic rate
- Reduced physical activity
If you are struggling with your weight, see your healthcare provider for guidance and support.
Read about the best exercise during menopause.
Can HT be used long term?
As is the case for most medications, the general recommendation with HT is to take the lowest dose possible for the shortest possible time. However, HT can be taken for as long as needed to control your symptoms if the benefits still outweigh the risks.
There is no set age at which you must stop HT. However, the risk-benefit profile of HT does change over time, with risks steadily increasing as you age.
For this reason, your healthcare provider will schedule an annual HT review. At these appointments, they will review your general health and any changes (e.g. new medical conditions) which may put you more at risk for side effects.
If you have had early menopause, before the age of 45, your healthcare provider will likely recommend taking HT for longer than other people – at least until the average spontaneous age of menopause. This is because early menopause can increase your risks of osteoporosis and cardiovascular disease. Taking HT helps to prevent this.
Vaginal HT in the form of estrogen gels, creams, suppositories, and rings is very low risk. This is because the type of estrogen used is not absorbed into the bloodstream. Vaginal HT is so safe that many women use it for decades with no concerns – even into their eighties and beyond.
Read our guide to when and how to stop taking HT.
Discover your personalized treatment options
Is HT unnatural?
One commonly-held belief about menopause is that it is a natural part of life and that we should all simply grit our teeth and get on with it. But by the same logic, illness, and disease are ‘natural’ parts of life, for which we now happily have many effective treatments!
Menopause symptoms can be disruptive and distressing. If this is the case for you, it is absolutely reasonable to consider treatments including HT.
This is not just a philosophical discussion – even the medications used for HT are most often the same hormones produced by your body.
Most of the estrogens used in HT today are body identical and derived from plants, including soybeans and yams. This means that the type of estrogen in the medication is identical to that produced naturally by your body. The most commonly used is 17 beta-estradiol, and this can be supplied in the form of pills, patches, sprays, and gels.
In contrast, synthetic estrogens are used in some other products, including the combined contraceptive pill. Other, older products include naturally occurring estrogens but not the same substances as human hormones which are thought to come with higher risks. Some people find these kinds of estrogen ethically unpalatable because they are extracted from the urine of pregnant horses.
Many also need to take progesterone alongside estrogen as part of their HT. Micronized progesterone, also known as Prometrium, is a body-identical type of progesterone, meaning that it is identical to the progesterone produced by your body. It can be taken orally or – in some cases – vaginally. Evidence is still emerging, but a review found that micronized progesterone comes with a lower risk of breast cancer than other types of progesterone.
While HT is the most effective way to reduce menopausal symptoms, it isn’t the only option. Hormone-free treatments for menopause include other medications, CBT, and lifestyle changes.
Can you take HT if your symptoms are mild?
HT can provide relief for mild to severe symptoms. If HT is a suitable treatment for you, it’s up to you when you start. Some people choose to start early, while others prefer to wait to see if things get worse. Both of these are reasonable choices.
The most important thing is to weigh the risks of HT treatment against its benefits in your personal case. This varies from person to person and depends on your lifestyle and medical history as much as your menopause symptoms. It can be complicated, so your healthcare provider will help you figure out the best decision.
Does HT work straight away?
HT is the most effective treatment for menopause symptoms, but it can take a while to start working.
Some people will feel better within a few days of starting, whereas others may find it takes weeks or even months. This is because it can take time for your body to adjust to the new hormones being supplied by your HT.
If you have not felt any (or enough) benefit within three months of starting, speak to your healthcare provider. They may be able to suggest a different dose or type of HT. They might also want to re-evaluate your symptoms to check that they are being caused by menopause.
Final word
We hope that this post has debunked some common misunderstandings about HT.
Find out more about menopause on our blog or in our symptoms library.
- Cancer Research UK page on risk and breast cancer
- National Institute for Health and Care Excellence (2019) Menopause: diagnosis and management (NICE Guideline 23). Accessed 4th January 2022
- Hillard, T. et al (2017). Management of the Menopause. ed. London: British Menopause Society, pp. 75-76, 82-99, 130-140 and 158-165
- P. Stute, L. Wildt & J. Neulen (2018) The impact of micronized progesterone on breast cancer risk: a systematic review, Climacteric, 21:2, 111-122, DOI: 10.1080/13697137.2017.1421925
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