HT is an effective and widely used treatment for menopause symptoms including hot flashes, sleep problems, and mood changes. There are a lot of myths and misunderstandings surrounding HT – it shouldn’t be this way. One study estimated that about 9% of American women aged 45 – 80, or 8.3 million people use it. 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. HT might not change your risk.
Estrogen-only HT and breast cancer risk
Estrogen-only HT (used if you have had your uterus removed) is not associated with any increased risk of breast cancer. In some studies, estrogen alone seemed to reduce the risk.
Combined HT and breast cancer risk
Oral HT which contains both estrogen and progesterone does increase your risk. But how much?
Based on the data from one large randomized trial (the WHI), there would be one extra case of breast cancer per year in a group of a thousand women in their 50s who were taking combined oral HT (estrogen and progesterone).
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 breast cancer risk and HT.
Does HT increase the risk of cardiovascular disease?
HT is not thought to cause any increase in your cardiovascular risk. In fact, 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). However, for women over 60 and more than 10 years from their last menstrual period, HT does appear to increase their risk of heart attack and stroke.
Does HT make you gain weight?
HT does not cause more weight than average for people of the same age. 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 very common to see changes in your weight around this time – a gain of about one pound per year is normal in middle age.
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 considered at any age for as long as needed to control disruptive symptoms. However, regular assessments with your menopause care provider are important to keep assessing 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.
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 can be used bywomen into their 70s, 80s and 90s with no concerns.
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 identical to the hormones that your body makes naturally and derived from plants, including soybeans and yams. The most commonly used is 17 beta-estradiol, and this can be supplied in the form of pills, patches, sprays, and gels.
Synthetic estrogens are used in some products, including the combined contraceptive pill. Some older HT is “natural” but includes naturally occurring estrogens extracted from the urine of pregnant horses. Some people have ethical concerns about the products, even though they are natural.
Many also need to take progesterone alongside estrogen as part of their HT. Micronized progesterone 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.
Read more about the difference between body-identical HT and compounded bio-identical HT.
Can you take HT if your symptoms are mild?
All medicines come with risks. If your symptoms are mild, you and your healthcare provider should discuss other options that could relieve your symptoms. There is no objective measure of symptom severity. If your symptoms are disrupting your life you should consider any treatments that could help.
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.
Read more about the benefits and risks of HT.
Does HT work immediately?
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 six weeks 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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