Is Hormone Replacement Therapy Safe For Menopause?

Menopause has long been a hush-hush topic, something on the periphery of our minds that no one really wants to talk about. (Except maybe in hushed whispers with your best friend while fanning yourself furiously.) Thankfully, those days are fading. Whether in Reddit threads or the group chat, women are finally sharing their menopause journeys, rendering “the change” a little less mysterious — and a lot less lonely.

According to the National Institutes of Health (NIH), 1.3 million American women enter menopause each year, and 1.1 billion women will be in perimenopause globally by 2025. “For many of them it’s sudden, unexpected. Nobody warned them, and it can feel like a truck slammed into them,” endocrinologist Vinita Tandon, MD, tells PS. “‘Who am I? What body is this? Where are my emotions?’ — they don’t have control.”

The newfound transparency about menopause couldn’t come at a better time, according to gynecologist Mary Farhi, MD. “Women need accurate information to understand what’s happening, that it’s not a disease, and they don’t need to be afraid of it,” she says. “But if symptoms are impacting their quality of life, there’s also absolutely no reason to suffer.”

Taking control of your health during this (completely normal) transition starts with knowledge and understanding your options, including menopause hormone therapy (MHT), more commonly known as hormone replacement therapy (HRT). Here, experts break down everything you need to know.

Experts Featured in This Article:

Vinita Tandon, MD, is a board-certified endocrinologist and medical director at Lifeforce, a health membership program.

Mary Farhi, MD, is a board-certified gynecologist and menopausal medicine specialist based in Illinois.

What is Menopause?

Menopause occurs when your body produces less of the hormones estrogen and progesterone, and is official after you’ve missed your period for 12 consecutive months. While the average age for women in the US to start menopause is 52 years old, the journey often begins years earlier with perimenopause, starting in a woman’s late 30s or early 40s. And while it’s a natural part of aging, it can bring some pretty significant hormonal changes.

According to The Menopause Society, 80 percent of women experience symptoms including hot flashes, night sweats, mood swings, sleep disruptions, joint pain, UTIs, brain fog, decreased sexual functions, and mental health challenges during their menopause journeys. Yeah, it’s a ride.

While half of the population goes through menopause, less than 15 percent of women receive effective treatment for their symptoms, according to a 2023 Cell Press study. Many doctors lack adequate training in menopause, which leaves women to feel dismissed and unsupported. This dismissal has real consequences; untreated menopause can lead to serious health issues, lost wages, and even career disruption. Enter hormone replacement therapy (HRT), which endeavors to help women navigate this transition with greater ease and well-being.

How Is HRT Used For Menopause?

Hormone replacement therapy utilizes hormones to replace the estrogen and progesterone that your body produces less of during menopause. It can come in the form of pills, patches, creams, gels, sprays, and even vaginal rings.

As women approach menopause, their ovaries gradually produce less estrogen and progesterone. These hormonal shifts are the root cause of most menopausal symptoms. HRT works by supplementing these declining hormones, essentially “topping up” your body’s natural supply to restore balance.

The primary function of HRT is to replace hormones, but it can have a positive ripple effect on overall wellness. “It’s the only treatment that I can think of in medicine that cures so many ailments and symptoms at once,” says Dr. Tandon. “And it’s much safer than being on long-term sleep medication or antidepressants.”

There are different types of HRT, tailored to individual needs. Some common forms include:

Why Are People Cautious About HRT?

For years, the go-to advice surrounding HRT was laced with fear and uncertainty. A Women’s Health Initiative study, published in 2002, linked HRT to an increased risk of breast cancer, stroke, and heart disease. The headlines caused widespread panic, leading many women to be denied access to HRT or avoid it altogether. Five years later, a deeper dive into the demographics of the study’s 60,000 participants found that nearly two-thirds were postmenopausal women over 60. Many were smokers, and some had previous medical conditions that gave them a higher chance of complications.

As Dr. Tandon puts it, “Many of us feel like this was one of the biggest travesties in medicine because 30 percent of women could have prevented heart disease if they had been on hormone therapy during these two decades.”

The good news is that the study has been debunked, and new research paints a much rosier picture. Modern HRT formulations — particularly those using bioidentical hormones and transdermal delivery methods, like patches and creams — offer big benefits with a low risk of adverse events, especially for women under 60.

What Are the Benefits and Risks of HRT?

HRT can alleviate many of the most bothersome menopause symptoms, including hot flashes, night sweats, sleep disturbances, mood swings, and vaginal dryness. “Besides just helping their symptoms of menopause, we know that hormone therapy has other health benefits for women,” says Dr. Farhi. “HRT reduces your risk of cardiovascular disease, diabetes, and osteoporosis while you’re taking it.”

That being said, HRT is not a magic bullet. It won’t erase your wrinkles or turn back time, and there are potential risks. Although the initial concerns about HRT have been largely debunked and modern formulations are widely considered safe, some studies have suggested a slightly increased risk of blood clots, stroke, and breast cancer in certain women — particularly those with specific risk factors or when HRT is used for extended periods. These risks are generally small, and the benefits of HRT often exceed the risks for many women. To determine if HRT is right for you, have an open and honest conversation with your doctor.

Who Should Consider HRT?

According to Dr. Tandon, “almost every woman” is a candidate. But finding the right HRT plan — or any menopause management plan — requires an approach based on your needs and health history. Dr. Farhi adds some specifics: “A history of hormone-positive cancer, like breast cancer or endometrial cancer, or history of a blood clot in your leg or your lung — those would be the two most common absolute contraindications to hormone therapy.”

With HRT, timing is key. The research behind this therapeutic window suggests that the sooner you start it, ideally right at the onset of menopause, the more benefits you have. “We know from the WHI study that there is a certain timeframe for the benefits [of HRT] to potentially outweigh the risk — that would be within 10 years of menopause or less than 60 years old,” says Dr. Farhi.

If your doctor isn’t well-versed in menopause care, seek a specialist who can give the support and guidance you need. Dr. Farhi recommends finding a menopause-certified practitioner through the Menopause Society. More than anything, don’t be afraid to advocate for yourself and ask questions. As Dr. Tandon advises, “You have to be a squeaky wheel and put yourself first.”

Is HRT Safe For Menopause?

The safety of HRT has historically been cause for concern. Still, the truth is that for most women (especially those under 60 and within 10 years of menopause) HRT is generally safe and effective for treating menopause symptoms. Dr. Farhi maintains that with factual information and support, women can navigate their menopause journey with confidence — and maybe even celebrate the new possibilities it brings.

Britt Stephens is a freelance writer and former content director at PS.