Opinion article
HRT in menopause: what the evidence says today
For a long time, hormone replacement therapy (HRT) was avoided out of fear of breast cancer and cardiovascular events, largely following the initial publication of the Women’s Health Initiative study in 2002. More recent analyses of that same study, along with many other studies published since, have shown that the risks had been overstated for most women, especially those who start HRT close to the onset of menopause.
What it treats
HRT treats vasomotor symptoms (hot flushes and night sweats), vaginal dryness, sleep and mood changes linked to menopause, and helps prevent bone density loss. For many women, it is the most effective treatment available for these symptoms.
The window of opportunity
Current evidence points to a more favourable risk profile when HRT is started before age 60 or within ten years of the last period. Outside this window, the balance between benefits and risks shifts, and each case needs individual assessment.
Types and routes of administration
- Transdermal oestrogen (patch or gel): linked to a lower risk of venous thrombosis than the oral route, since it avoids first-pass liver metabolism.
- Progestogen: required whenever a uterus is present, to protect the endometrium.
- Local vaginal oestrogen: specifically for vaginal dryness and atrophy, with minimal systemic absorption.
When to avoid it
A personal history of breast cancer or other hormone-sensitive cancers, unprovoked venous thromboembolism, active liver disease and unexplained vaginal bleeding are, among others, situations that need careful assessment before considering HRT.
The decision to start HRT is individual, made in consultation, weighing symptoms, clinical history and each woman’s own risk factors. There is no single right answer for everyone.
This article is for information only and does not replace a medical consultation.