Thinking About the Benefits of HRT
Hormone replacement therapy attracts steady attention in the press, often as current studies report different effects on women's health. Over the years this coverage has left many women hesitant, avoiding treatment as they fear the side effects more than the symptoms in front of them. The picture, in my opinion, deserves a calmer and more balanced reading.
This concern traces back to the Women's Health Initiative, a landmark study launched in 1991 by Dr Bernadine Healy, the first woman to direct the United States National Institutes of Health. Part of this large American trial was stopped early, after combined oestrogen and progestogen therapy was linked to higher rates of breast cancer, heart disease, stroke and blood clots among the women taking it. The coverage was sensational, and the United Kingdom's own Million Women Study echoed the breast cancer signal soon after. Both findings shaped a generation of cautious prescribing.
Our understanding has moved on considerably since then. Researchers later recognised that the women in the original trial were older, many of them in their sixties, which skewed the risk picture for younger patients. The British Menopause Society now advises that HRT started before the age of 60, or within ten years of menopause, carries a favourable balance of benefits to risks, and is likely to reduce coronary heart disease and cardiovascular mortality. Timing and individual circumstances, in other words, change the calculation a great deal.
Consider the Benefits
There are sound clinical reasons why so many women choose HRT. In England alone, around 2.8 million patients were prescribed HRT in 2024 to 2025, a figure that has risen almost every year since 2015. The symptoms it addresses can be very disruptive, and include hot flushes, night sweats, headaches and broken sleep. Beyond the immediate discomfort sit longer-term concerns that follow the loss of oestrogen, including osteoporosis, cardiovascular disease, low mood and a raised risk of stroke.
It also helps to keep the risks of HRT in proportion against everyday factors that attract far less attention. Researchers estimate that around 27 per cent of breast cancer cases in the UK are linked to modifiable lifestyle factors, more than a quarter of all cases diagnosed. Alcohol alone is thought to account for roughly 8 per cent of female breast cancers, and carrying excess weight raises the risk further still. Set against risks that many women already carry, the added risk from carefully managed HRT is often smaller than they expect.
HRT works by replacing the oestrogen that the body stops producing at menopause. Restoring this hormone eases the symptoms and offers protection against several longer-term conditions. The clearest benefit is to bone strength, with a likely reduction in coronary heart disease when treatment starts early, alongside continuing research into how oestrogen affects the brain.
How I Approach HRT in Practice
In my practice, HRT holds a valuable place in treating the more unpleasant symptoms of menopause and premenstrual syndrome, in protecting against bone loss, and in supporting women through postnatal depression. I tend to favour topical oestrogens applied through the skin, as they carry a lower risk of venous thrombosis and pulmonary embolism than tablets taken by mouth. Used alongside a Mirena coil, which keeps progesterone exposure to a minimum, they offer a measured and well-tolerated approach for many of my patients.
Combined HRT does carry a small increase in breast cancer risk, which is why I review each woman's history and personal circumstances carefully before recommending any treatment. The aim is always a plan suited to the individual rather than a single approach applied to everyone.
Through my private London clinic, I provide HRT counselling and personalised advice on each woman's breast cancer and cardiovascular risk. I can also arrange testing for inherited clotting disorders such as Factor V Leiden, which is more common in people of Northern European descent, along with the thrombophilias seen more often in those of Ashkenazi Jewish heritage, as well as screening for breast cancer risk factors.
I also cover the full range of gynaecological care, including vaginal and hysteroscopic surgery, as well as rapid endometriosis testing. To talk through your options or book an appointment, please call our friendly team today on 020 8371 1510, or email secretary@rapidaccessgynaecology.co.uk.