All about hormone replacement therapy (HRT)
The benefits and risks of taking HRT to treat the symptoms of menopause
Menopause is a time in life when the ovaries stop producing the hormones estrogen and progesterone and menstrual periods stop. Anyone with ovaries can experience menopause, including women and trans, non-binary and gender-diverse people. This usually happens between the ages of 45 and 55 but can vary. Some people may reach menopause early as a side effect of medical treatment such as chemotherapy or having the ovaries removed.
Symptoms of menopause include hot flashes, mood swings and trouble sleeping, but everyone’s experience is different. Some people may not be bothered by symptoms, while others may find it hard to cope with them. Treatment options are available to help ease symptoms.
Why would a woman in menopause take HRT?
Some women take hormone replacement therapy (HRT) to ease menopausal symptoms. HRT is medicine that contains hormones that the ovaries make less of as women age and reach menopause.
HRT can be taken as estrogen only or as a combination of estrogen and progestin (combined HRT). Combined HRT is more commonly used. Estrogen-only HRT can increase the risk of uterine cancer (cancer of the uterus), so it is usually only recommended for women who have had a hysterectomy (surgery to remove the uterus).
Combined HRT:
- relieves menopausal symptoms
- improves cognitive function, memory and overall mental well-being
- protects against osteoporosis (thinning of the bones)
- may reduce the risk of colorectal cancer
HRT may also have a positive impact on:
- cardiovascular health, by maintaining healthy cholesterol levels
- skin and hair, by enhancing elasticity and reducing dryness
- sexual health
Overall, HRT can improve quality of life during menopause.
It’s important to understand the risks associated with HRT before making a decision about taking it. The risks are different for different people and are influenced by factors such as personal health history, age, how long someone takes HRT for, the dosage and the type. Research shows that long-term use of combined HRT (for 5 or more years) slightly increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism (blood clots in the lungs). The research also suggests that the benefits of taking combined HRT for the shortest length of time necessary outweigh the risks for healthy women under the age of 60 or within 10 years of the start of menopause.
The decision to take HRT is personal and should be made with the help of your healthcare provider. Talk to your healthcare provider about cancer, heart disease and stroke when considering the benefits and risks of HRT.
Our recommendation
Hormone replacement therapy (HRT) is an effective way to reduce menopausal symptoms and improve quality of life for people experiencing menopause. Some studies show that HRT may increase your risk of breast and ovarian cancer while other studies show no increased risk.
If you are thinking about taking HRT, the Canadian Cancer Society recommends that you talk to your healthcare provider about how HRT can relieve menopausal symptoms and about your individual risks. Low-dose HRT may slightly increase your risk of breast and ovarian cancer, but the risk can be kept low by using it for as short a time as possible.
HRT and cancer
Combined HRT (estrogen and progestin) is associated with a small increased risk of breast and ovarian cancer. This risk may be influenced by individual factors, how long someone takes HRT for, and the time between starting menopause and starting HRT.
Studies show that combined HRT increases the risk of breast cancer – but the risk is low. Regular breast cancer screening is recommended for all women aged 40 to 74, including those taking HRT.
Studies suggest that both combined and estrogen-only HRT increase the risk of ovarian cancer – but the risk is low.
Research shows that estrogen-only HRT increases the risk of uterine cancer in women who have a uterus (haven’t had a hysterectomy). Because of this risk, these women are usually given combined HRT.
Some studies suggest that people who take combined or estrogen-only HRT may have a lower risk of colorectal cancer, while other studies do not. HRT is not recommended to prevent colorectal cancer.
HRT after cancer
If you have a history of cancer and are thinking about taking HRT, you should talk to your healthcare provider about the risks:
- Women with a history of breast cancer may be advised not to take HRT. This is because there are concerns that the estrogen in HRT may cause breast cancer to come back. Different studies tell us different things about the effects of HRT on women with breast cancer, so the risk is not yet fully understood.
- HRT may be an option for women at a higher risk for breast cancer. Although women with an increased risk for breast cancer are usually advised not to take HRT, it might be advised if they have proper counselling and follow-up.
- Women with a history of certain types of uterine cancer may be advised not to take HRT. Women who have had higher stage and higher grade uterine tumours have a higher risk of the cancer coming back.
Alternatives to HRT
Women who experience menopausal symptoms often seek relief in ways other than HRT. Not all of the alternatives to HRT have been scientifically proven, but many people do find them helpful.
Are bioidentical hormones more effective and less risky than HRT?
Some hormone products, which may be called bioidentical hormones, are available without a prescription. Bioidentical hormones are made from plant sources and are basically the same as hormones made by our bodies. You may have heard claims that these products are more natural, effective and safe than HRT, but there is no scientific evidence to prove this.
Not all of the alternatives to HRT have been tested to evaluate side effects. HRT may still be useful to ease the symptoms of menopause on a short-term basis if other treatments do not work and the symptoms are severe.
Always check with your healthcare provider before deciding on HRT, herbal products or lifestyle changes.