Menopause: Frequently Asked Questions about Hormone Replacement Therapy

This is the ninth and last part of our series about the menopause based on our booklet “Fast Facts for Patients: Menopause”, which is freely available online. This article gives answers to frequently asked questions about hormone replacement therapy.

Q: I’m not having many menopausal symptoms, so do I need hormone replacement therapy (HRT)?

HRT is recommended for most women, because it:

protects against the development of possible peri-menopausal symptoms in the future
provides important long-term protection against osteoporosis
protects the vaginal tissues and bladder.

For women aged up to 60 who are in good health, the benefits of HRT far outweigh any risks.

Q: When should I start HRT?

You can start HRT at any time during the menopause transition. It will help with the symptoms and also provide the long-term benefits we have talked about.

HRT can also be started after the actual menopause and will help with any symptoms that continue. It will also protect the bones from osteoporosis.

However, HRT confers no cardiovascular disease (CVD) benefit if it is started outside the window of opportunity (within 5–6 years of the start of the menopause transition).

Q: How long should I take HRT for?

There is no specific age at which you should stop HRT – you can discuss this with your doctor, nurse or pharmacist.

Women are encouraged to take HRT until age 60, to get the full benefits in terms of protection against osteoporosis and CVD.

Women with premature ovarian insufficiency (when the ovaries stop working and no longer produce oestrogen) should continue HRT until at least age 52 (the average age of the menopause).

Q: I couldn’t have the contraceptive pill. Can I have HRT?

The levels of hormones in HRT are much lower than in the contraceptive pill. Women who couldn’t take the pill (because they have other health conditions or risk factors or side effects) can still take HRT.

Blood pressure increases with age. Oestrogen can raise blood pressure further in some women, but for most women blood pressure remains normal for their age.

Q: What if my symptoms do not improve?

Your doctor will start you on a low dose of HRT, aiming to relieve symptoms with the lowest dose that works for you. You may need to try a higher dose or a different type. Women in their 40s may need higher doses than older women.

Q: What are the side effects of HRT?

The main possible serious side effect of HRT is deep vein thrombosis (DVT) but the risk is low in otherwise healthy women.

Some women experience nausea, breast tenderness and headache when they start taking HRT but this usually passes with time.

Q: Will I put on weight?

HRT does not directly cause women to put on weight. However, hormones can increase appetite, and oestrogen can cause fluid retention, which will increase bodyweight.

You need fewer calories as you get older, because your metabolism slows down, so it is important to reduce your calorie intake to make sure that you don’t put on weight.

Please check out the previous and the next post of our series here:

Information based on Fast Facts for Patients: Menopause (Karger, 2021).