HRT: A Grown-Up Conversation

Few topics in women's health carry more baggage than hormone replacement therapy. Here's a calm look at what the evidence says.

What it is

HRT (also called MHT, menopausal hormone therapy) replaces the oestrogen your ovaries stop producing — usually combined with progesterone if you have a uterus. It comes as patches, gels, sprays, tablets, and local vaginal treatments.

What it's good at

HRT is the most effective treatment we have for hot flushes and night sweats, often reducing them dramatically within weeks. It also helps protect bone density, and many women report better sleep, mood, and joint comfort.

The 2002 scare, revisited

A large study was stopped early over breast cancer and heart risks, and prescriptions fell off a cliff. Twenty years of reanalysis later, the picture is more nuanced: for most healthy women who start HRT before 60 or within 10 years of menopause, benefits generally outweigh risks. Risk varies with your personal and family history — which is exactly why this is a conversation, not a verdict.

Questions worth bringing to your doctor

• Given my history, what are my personal risks and benefits?
• Is transdermal (patch/gel) safer for me than tablets?
• If not HRT, what else can we try for my symptoms?
• When should we review the decision?

The bottom line

Neither "HRT is dangerous" nor "HRT is a miracle" is true. You deserve an individual answer from a clinician who takes your symptoms seriously. If yours waves you off, it's okay to seek a second opinion.