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Hormone replacement therapy (HRT)

 

Hormone replacement therapy (HRT) is taking female sex hormones to replace hormones that your ovaries no longer make after menopause. These hormones could be oestrogen, progesterone or both. If treatment for cervical cancer has triggered an early menopause, HRT may help ease the symptoms. 

Read more about menopausal symptoms >

On this page, we talk through different types of HRT, how it can be taken, and the benefits and possible risks. In this section, we also have pages on:

Types of HRT

There are 2 main types of HRT:

  • Oestrogen-only HRT. If you have had a hysterectomy, you usually have this type of HRT. 
  • Combined HRT. This type has oestrogen and progestogen, which is a man-made version of progesterone. If you have a womb, you can only have this type of HRT. 

There are some other hormone therapies, such as progestogen-only, but these are used less often.

If HRT does not affect the cervical cancer or your treatment, there is no reason you should not have it if you want to. However, you may feel uncomfortable or upset at the thought of another treatment, so take some time to think about it. It may help to speak with your doctor so you feel completely confident about any decision. 

Read more about who can take HRT on the NHS website >

How is HRT given?

You can have HRT in different ways. It may be difficult to decide which type of HRT is best for you. Your doctor can advise about which type is most likely to ease any menopausal symptoms you have. You may need to try a few different types to find one that suits you.

Ways to take HRT When to take HRT Types of HRT
Tablets Once a day

Oestrogen-only and combined

Skin patch Once every few days

Oestrogen-only and combined

Gel Once a day

Oestrogen-only

Vaginal oestrogen Once a day

Oestrogen-only

 

If you have a womb, you may be offered progestogen-only HRT alongside oestrogen. This is usually given through an intrauterine releasing system (IUS), which is a small, T-shaped plastic device that is put into your womb. A progestogen-only IUS can stop that lining of the womb from becoming thicker (endometrial hyperplasia). An IUS is put in once every 5 years.

How long can I have HRT?

If you have had premature ovarian insufficiency (POI) or an early menopause, it is important to take HRT until the age of about 50, as this is when the menopause would naturally start. After this age, you can review your symptoms and risk factors to decide if you want to continue HRT.

Read more about the benefits and possible risks of HRT >

If you have any questions or worries, tell your healthcare team. They will know your individual situation and can support you.

Side effects of HRT

Like most medicines, HRT may cause some side effects. Any side effects usually go away within 3 months of starting HRT.

Side effects of HRT include:

  • breasts feeling tender
  • headaches
  • feeling sick (nausea)
  • indigestion
  • stomach (abdominal) pain
  • vaginal bleeding.

If you are worried about any side effects, including ones we don't mention here, speak with your healthcare team. They will be able to help you manage them. 

Benefits and possible risks of HRT

HRT helps make symptoms of the menopause better, which can improve your quality of life. It may help you feel like you again and mean you can continue your usual routine with less disruption. 

There have been lots of news stories about the risks associated with HRT, which may have worried you. Like all treatments, there are some risks that come with taking HRT. But most of these risks are small and the benefit to you may outweigh them. 

It is important to remember that other factors, like your age and the dose of HRT you take, also contribute to any risks. 

Breast cancer

It is true that using combined HRT for more than 5 years increases your risk of developing breast cancer slightly – but it is important to understand that this is a very small risk. For example, being overweight or having 3 alcoholic drinks a week are bigger risks  in developing breast cancer. Once you stop taking HRT, your risk goes back to normal over time. 

Ovarian cancer

Like with breast cancer, your risk of developing ovarian cancer increases slightly if you use any type of HRT for more than 5 years. Again, it is important to understand how small this risk is – in real terms, an extra 1 in 1,000 HRT users may develop ovarian cancer . Once you stop using HRT, your risk goes down again over time.

Blood clots

Evidence shows that:

  • taking HRT tablets can increase your risk of blood clots
  • HRT skin patches or gels do not increase your risk of blood clots – if you have a history of blood clots, your doctor may recommend you have this type of HRT.  

In real terms, less than 2 out of every 1,000 women who have been using HRT for over 7 years will develop blood clots, so the risk is small. 

These risks can sound worrying, especially after a cervical cancer diagnosis. But it is important to understand these risks are small and, for most people, the benefits of taking HRT outweigh any risks. If you have questions or are worried about taking HRT, it is best to speak about your individual situation with your doctor. 

Read more about other ways to manage menopausal symptoms >

More information and support

It may take some time for you to decide whether HRT is right for you. You may feel more comfortable making a decision after reading through the benefits and risks, and speaking with your doctor – they can help you make a decision based on your individual situation and preferences.  

We are also here to support you. If you have a medical question about the menopause or HRT, our Ask the Expert service could help.

Submit your question >

Or, if you want to chat about your experience with someone who gets it, we also have a free Helpline on 0808 802 8000 and online Forum where you can share.

Get support >

Other useful organisations

The Daisy Network
Provides support to women, along with their families and partners, who have been diagnosed with premature ovarian insufficiency.
www.daisynetwork.org

Menopause Matters
An independent website providing up-to-date, accurate information about the menopause, menopausal symptoms and treatment options.
www.menopausematters.co.uk/benefit.php

NHS
The NHS website has more information about HRT, including alternatives.
www.nhs.uk/conditions/hormone-replacement-therapy-hrt

Royal College of Obstetricians and Gynaecologists
Has an information hub about women’s health covering the menopause and beyond.
www.rcog.org.uk/en/patients/menopause

Women’s Health Concern
The women’s arm of the British Menopause Society (BMS). Provides a confidential, independent service to advise, reassure and educate women of all ages about their gynaecological and sexual health, wellbeing and lifestyle concerns.
www.womens-health-concern.org/help-and-advice/factsheets/hrt

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • National Institute for Health and Care Excellence (NICE), Sex hormones, Webpage: https://bnf.nice.org.uk/treatment-summary/sex-hormones.html, Accessed August 2019. 
  • Vogel L., Trial overstated HRT risk for younger women, Canadian Medical Association Journal, 2017. 
  • Allen NE. et al, Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute, 2009.
  • Collaborative Group on Epidemiological Studies of Ovarian Cancer, Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies, The Lancet, 2015.
  • Shoupe D., Individualizing Hormone Therapy to Minimize Risk: Accurate Assessment of Risks and Benefits, Women’s Health, 2011. 
  • Vinogradova Y., Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases, BMJ, 2019.
  • NHS, Risk – hormonal replacement therapy, Website: www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks, Accessed September 2019.

We write our information based on literature searches and expert review. For more information about all the references we used, please contact [email protected]

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"I hit menopause immediately and was on HRT before I left the hospital. It took a couple of attempts to find the one that suited me best"
Read Annie's story
Date last updated: 
20 Sep 2019
Date due for review: 
20 Sep 2022

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