Hormone Therapy Risks

“For healthy women with bothersome hot flashes aged
younger than 60 years or within 10 years of menopause,
the benefits of HT generally outweigh the risks”.1

Umbrella
What may the Hormone Therapy Risks Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT) Risks
  • Hormone Therapy (HT) Risks
  • Menopausal Hormone Therapy (MHT) Risks

Date

What can it be important to be clear about with hormone therapy (HT) risks information?

It can be important to be clear about the date of all information including the date of HT risks information, because this information may have been updated.

Symptoms or Chronic Conditions

What can it also be important to be clear about with HT risks information?

It can also be important to be clear about whether HT risks information is about the use of HT for the management of menopausal symptoms such as hot flushes, night sweats and vaginal dryness or for the prevention of chronic conditions such as cardiovascular disease, cancer, dementia and osteoporosis.

One Size Fits All

Are different types of HT available?

No. In HRT – Types, Doses and Regimes the (British) Women’s Health Concern elaborate on:

“Many types of HRT are available and there is not one type, dose or regimen which suits all women. It is important to understand which hormones are used, why and how so that for each woman who chooses to take HRT, the treatment is individualised to best suit her needs, taking into account types of symptoms, medical history, period pattern if present and current national recommendations and guidelines”.2

Risks

What are some risks associated with HT?

In Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT?, last updated 04 September 2023, the (Australian) Jean Hailes for Women’s Health (JH) elaborate on:

“Research shows there are some risks associated with MHT. The risks of hormone therapy differ depending on:

  • The type of medication
  • The dose given
  • How long the medication is used for
  • How the medication is given (e.g. patch or tablet)
  • When medication is started
  • Whether a progestogen is used
  • The type of progestogen used”.3

Risks vs Benefits

Are the risks of HT generally outweighed by the benefits?

In Risks and Benefits of MHT: Supporting Women Making A Decision the Australasian Menopause Society elaborate on:

  • “The risks of MHT must be considered in perspective for each woman and balanced against the benefits, particularly the severity of symptoms
  • Management of menopausal symptoms should be tailored to the individual woman to effectively manage her symptoms and minimise risks
  • For some women any extra risk will be unacceptable but others may feel that the benefits outweigh the risks”.4

NICE Guidelines

What did the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about the benefits and risks of hormone replacement therapy (HRT)?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT, last Updated: 05 December 2019, the NICE explain and elaborate on:

“NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your GP should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.

  • Blood Clots (Venous Thromboembolism)…
  • Heart Disease and Stroke (Cardiovascular Disease)…
  • Breast Cancer…
  • Type 2 Diabetes…
  • Osteoporosis…
  • Loss of Muscle Strength…
  • Dementia…”.5

Who is a GP?

DotS and/or DotC (Depending on the Country) a GP may be a qualified and registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Younger Than 60 Years

Younger than 60 years, do the benefits of HT generally outweigh the risks?

On page one in Deciding About Hormone Therapy Use: Potential Risks, published July 2022, the North American Menopause Society (NAMS) elaborate on:

“As with all medications, HT is associated with some potential risks. For healthy women with bothersome hot flashes aged younger than 60 years or within 10 years of menopause, the benefits of HT generally outweigh the risks”.6

In Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? the JH elaborate on:

“A recent comprehensive review of evidence on MHT found it is an effective and safe treatment for the relief of menopausal symptoms for healthy women. The data showed that MHT had low risks for women aged between 50 and 60 years, but more research is needed to understand how MHT might affect other women’s health issues”.7

Older Than 60 Years

Older than 60 years or postmenopausal for 10 years or more, is it recommended women do not start HT?

The JH note:


Hormone Therapy Risks
“It is not recommended you start MHT if you are older than 60 years or if you’ve been postmenopausal for 10 years or more”.8

After Age 65

In women older than 65 years, can starting HT increase the risk of dementia?

On page one in Deciding About Hormone Therapy Use: Potential Risks the NAMS explain:

“If started in women aged older than 65 years, HT might increase the risk of dementia”.9

Breast Cancer Risk

Can HT increase breast cancer risk?

On page one in Deciding About Hormone Use: Potential Risks the NAMS explain:

“Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time”.10

On page two in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause one of the recommendations is:

  • “Current evidence suggests that oestrogen alone HRT is associated with a lower risk of breast cancer than combined HRT. Breast cancer risk is duration dependent and may vary with the type of progestogen used. The risk of breast cancer should be considered in the context of the overall benefits and risks associated with HRT intake”.11

Other Conditions

Can HT increase the risk of other conditions?

In Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT) – Research Into HRT and Other Conditions, page last reviewed 08 February 2023, the NHS note:

“Research has shown that taking HRT has little or no effect on the risk of getting coronary heart disease.

More research is being done to find out how taking HRT affects some other conditions, such as dementia and diabetes. Any increased risk or benefit is likely to be small.

It’s not known whether HRT reduces the risk of dementia.

HRT does not increase the risk of developing type 2 diabetes. Some recent studies have suggested that it may even slightly reduce the risk”.12

Not Advised

When may using HT not be advised?

The JH note:

“Your doctor may advise you not to use MHT if it could increase your health risks. For example, if you have:

  • Cancer (e.g. breast or uterine)
  • Undiagnosed vaginal bleeding
  • Heart disease”.13

Health Care Provider

What if I choose to use HT, how can I find out what my risks and benefits are?

If you choose to use HT, it may be in your best interest to also choose to talk to your health care provider about this.

In BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women the British Menopause Society (BMS) and Women’s Health Concern (WHC) note:


Hormone Therapy Benefits and Risks“The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use”.14

On page one in Deciding About Hormone Use the NAMS explain:

“Every woman is different, and you will decide about whether to use HT based on the severity of your symptoms, your personal and family health history, and your own beliefs about menopause treatments. Your healthcare professional will be able to help you with your decision”.15

In Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy the (United States) Mayo Clinic note:

“Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change”.16

Health Topics A-Z

Where may I find Health Topics A-Z related to Hormone Therapy Risks?

In Health Topics A-Z may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. 20 Years of Data Lead To Changes In Perceptions, Usage of Menopausal HT
  2. 8 Myths and Truths About Menopausal Hot Flashes
  3. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  4. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  5. BMS Statement on Testosterone
  6. BMS TV: Bioidentical Hormones
  7. BMS TV: Hormone Replacement Therapy (HRT)
  8. BMS TV: HRT and Bleeding
  9. BMS TV: HRT and Breast Cancer: Overall Risks and Benefits
  10. BMS TV: HRT and the Risk of Breast Cancer
  11. BMS TV: Testosterone Explained
  12. BMS, IMS, EMAS, RCOG and AMS Joint Statement on Menopausal Hormone Therapy and Breast Cancer Risk In Response To EMA Pharmacovigilance Risk Assessment Committee Recommendations In May 2020
  13. Bioidentical Hormones: Are They Safer?
  14. Consumer Health: Menopause, Hormone Replacement Therapy and Heart Health
  15. Deciding About Hormone Therapy
  16. Deciding About Hormone Therapy Use
  17. Dr Louise Newson: The Truth About the Menopause & HRT
  18. Estrogen & Hormones
  19. Estrogen & Hormones: Postmenopausal Hormone Replacement Therapy
  20. Family History
  21. Find A Menopause Practitioner [United States and Other]
  22. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  23. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  24. Guidance on Menopausal Hormone Therapy
  25. HRT
  26. HRT & Menopause Extra
  27. HRT – Types, Doses and Regimens
  28. HRT: Benefits and Risks
  29. Hormone Replacement Therapy (HRT)
  30. Hormone Replacement Therapy (HRT) with Dr Nicky Peel & Prof. David Armstrong
  31. Hormone Replacement Therapy (HRT): Alternatives To Hormone Replacement Therapy (HRT)
  32. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT)
  33. Hormone Replacement Therapy (HRT): Types of Hormone Replacement Therapy (HRT)
  34. Hormone Therapy In Postmenopausal Persons: Primary Prevention of Chronic Conditions
  35. Hormone Therapy for Menopause
  36. Hormone Therapy: Is It Right for You?
  37. Hot Flashes
  38. Hot Flashes
  39. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  40. How To Find Relief for Hot Flashes At Night
  41. I Forgot To Ask the Doctor – E9: The Menopause. Can Every Woman That Wants It Have HRT?
  42. Index To Drug-Specific Information [United States]
  43. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause
  44. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  45. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  46. Learning To Cope With Hot Flashes
  47. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  48. Menopausal Hormone Therapy
  49. Menopausal Hormone Therapy and Breast Cancer Risk
  50. Menopausal Hormone Therapy and Venous Thromboembolism
  51. Menopausal Hormone Therapy and Women’s Health: An Umbrella Review
  52. Menopausal Hormone Therapy, Heart Disease and Stroke
  53. Menopause
  54. Menopause
  55. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  56. Menopause Hormone Therapy: Does It Cause Vaginal Bleeding?
  57. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Benefits of MHT?
  58. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT?
  59. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
  60. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  61. Menopause Patient Information [Videos] 3. The Risks & Benefits of HRT
  62. Menopause Patient Information [Videos] 4. The Different Types of HRT
  63. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  64. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  65. Menopause Symptoms and Relief
  66. Menopause Treatment
  67. Menopause Treatments: What Works, What Doesn’t
  68. Menopause and HRT
  69. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
  70. Menopause: Diagnosis & Treatment
  71. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT [NICE Guideline]
  72. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  73. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  74. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  75. Nonhormone Treatments for Hot Flashes and Night Sweats
  76. Revised Global Consensus Statement on Menopausal Hormone Therapy
  77. Risks and Benefits of MHT
  78. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  79. The Truth About Menopause Supplements | Dr Sarah Berry
  80. Therapy for the Effects of Menopause
  81. Tips To Help Manage Menopause Symptoms
  82. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  83. Types of Hormone Therapy
  84. Vaginal Dryness
  85. Vaginal Dryness After Menopause: How To Treat It?
  86. Vaginal Oestrogen
  87. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  88. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  89. Video Series-2023: Lifestyle Modification and Prevention of Breast Cancer
  90. Video Series-2023: NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  91. Video Series-2023: New FDA-Approved Nonhormone Option for the Treatment of Hot Flashes
  92. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  93. Videos and Podcasts: Videos – Interviews: Heart Disease, Risk Factors of Developing Heart Disease, and Can I Take Hormones?
  94. Videos and Podcasts: Videos – Interviews: Prevention of Chronic Diseases In Women: Where Does MHT Fit In
  95. Videos and Podcasts: Videos – Interviews: The Women’s Health Initiative – What Can We Believe
  96. Webinars: Previous – Breast Cancer
  97. Webinars: Previous – Management of Menopause In Patients With Obesity
  98. Webinars: Previous – The Early Menopausal Patient
  99. What Everyone Should Know About Menopause Symptoms
  100. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Deciding About Hormone Therapy Use: Potential Risks. July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 16 September 2023
  2. HRT – Types, Doses and Regimes. Published Date: September 2021. British Menopause Society https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-types-doses-and-regimens/ Accessed: 16 September 2023
  3. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 04 September 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 September 2023
  4. Risks and Benefits of MHT: Supporting Women Making A Decision. Content Updated January 2021. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/risks-and-benefits-of-mht-hrt Accessed: 16 September 2023
  5. Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 16 September 2023
  6. Deciding About Hormone Therapy Use: Potential Risks. July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 16 September 2023
  7. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 04 September 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 September 2023
  8. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 04 September 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 September 2023
  9. Deciding About Hormone Therapy Use: Potential Risks. July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 16 September 2023
  10. Deciding About Hormone Therapy Use: Potential Risks. July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 16 September 2023
  11. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. First Published Online 10 June 2022:2. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 16 September 2023
  12. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT) – Research Into HRT and Other Conditions. Page Last Reviewed: 08 February 2023 https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/ Accessed: 16 September 2023
  13. Menopause Management Options: Menopausal Hormone Therapy (MHT) – What Are the Risks of MHT? Last Updated: 04 September 2023 | Last Reviewed: 19 August 2022. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management/ Accessed: 16 September 2023
  14. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women. Updated March 2021. British Menopause Society and Women’s Health Concern https://thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/ Accessed: 16 September 2023
  15. Deciding About Hormone Therapy Use: Potential Risks. July 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 16 September 2023
  16. Menopause: Diagnosis & Treatment – Treatment: Hormone Therapy. 25 May 2023. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401 Accessed: 16 September 2023
Topic Last Updated: 16 September 2023 – Topic Last Reviewed: 16 September 2023

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