Science.
The use of hormone replacement therapy (HRT) for menopause and peri-menopause is supported by evidence from scientific studies, and recommended by the Australian and International Menopause Society.
The list below contains some of the most relevant studies. For science supporting the use of dietary intervention for weight loss and chronic disease please click here.
Prescribing of HRT
Topical estrogen is body identical and the safest way of giving estrogen, with no risk of venous thromboembolism and very few contra-indications.
L’Hermite M. HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT. Climacteric 2013; 16: 44-53.
Newson L, Lass A. Effectiveness of transdermal oestradiol and natural micronised progesterone for menopausal symptoms. BJGP 2018; 68: 499-500
Vinogradova Y, Coupland C, Hippisley-Cox J Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2019;364:k4810
Straczek C, Oger E, Yon de Jonage-Canonico MB, et al. Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: Impact of the route of estrogen administration. Circulation 2005;112(22):3495–500. doi: 10.1161/CIRCULATIONAHA.105.565556.
Mueck AO. Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermal estradiol and micronized progesterone. Climacteric. 2012 Apr; 15 Suppl 1:11-7.
Hypertension is not a contraindication to taking HRT (although it’s important to appropriately manage all cardiovascular risk factors)
NICE. Menopause: diagnosis and management. NICE Guideline [NG23]. 2015. Available at: www.nice.org.uk/guidance/NG23
Women with a high risk of breast cancer, even for those with BRCA mutations, do not have a greater increase in risk with HRT than that observed with HRT in the general population.
Eisen A, Lubinski J, Gronwald J, et al. Hereditary Breast Cancer Clinical Study Group. Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers. J Natl Cancer Inst 2008;100(19):1361–67. doi: 10.1093/jnci/djn313.
Progestogens, specifically micronised progesterone and dydrogesterone, may be associated with a lower risk of breast cancer than medroxyprogesterone acetate.
Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab 2019;104(5):1595–622. doi: 10.1210/jc.2019-00221.
Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric. 2018 Apr;21(2):111-122. doi: 10.1080/13697137.2017.1421925. Epub 2018 Jan 31. PMID: 29384406.
Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.[Erratum appears in Breast Cancer Res Treat. 2008 Jan;107(2):307-8]. Breast Cancer Res Treat. 2008 Jan;107(1):103-11.
Micronised progesterone does not increase risk of clot
Mirkin S. Evidence on the use of progesterone in menopausal hormone therapy. Climacteric. 2018 Aug; 21 (4): 346-354.
No difference in all-cause mortality with HRT (lower all-cause mortality in women 50–59 years taking HRT)
Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: The Women’s Health Initiative randomized trials. JAMA 2017;318(10):927–38. doi:10.1001/jama.2017.11217.
There’s no need to limit duration of HRT
Baber RJ, Panay N, Fenton A, IMS Writing Group. 2016 recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016;19(2):109–50. doi: 10.3109/13697137.2015.1129166
Women who stop HRT increase their risk of cardiovascular and cerebrovascular death.
Mikkola TS, Tuomikoski P, Lyytinen H, et al. Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab 2015;100(12):4588–594. doi: 10.1210/jc.2015-1864.
More than 20% of women will have moderate-to-severe symptoms after discontinuing MHT
Ockene JK, Barad DH, Cochrane BB, et al. Symptom experience after discontinuing use of estrogen plus progestin. JAMA 2005;294(2):183–93. doi: 10.1001/jama.294.2.183.
Most women will have menopausal symptoms for up to eight years, and 20% will have symptoms into their 60s and 70s.
Gartoulla P, Worsley R, Bell RJ, Davis SR. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause 2018;25(11):1331–38. doi: 10.1097/GME.0000000000001237.
Transdermal estrogen does not increase the baseline risk of clot in women with Factor V Leiden
Straczek C et al. Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration. Circulation. 2005 Nov 29; 112 (22): 3495-500.
Most women with cancer (or who have had cancer) can safely take HRT, including non-estrogen-dependant breast cancer
Purohit P, Sassarini J, Lumsden MA. Management of Induced Menopause in Gynaecological Cancers and Their Challenges. Curr Obstet Gynecol Rep 2019; 8: 94–102.
Benefits of HRT
The benefits of HRT outweigh the risks for the majority of women.
Baber RJ, Panay N, Fenton A, Group IMSW. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 2016;19:109-50
HRT reduces the risk of women developing heart disease by 30-50%.
Boardman HMP et al. Hormone therapy for preventing cardiovascular disease in postmenopausal women. Cochrane Database Syst Rev. 2015 Mar 10; (3): CD002229.
HRT reduces the risk of developing type 2 diabetes, bowel cancer, dementia, and depression.
Lobo RA et al. Prevention of diseases after menopause. Climacteric. 2014 Oct; 17 (5): 540-56.
HRT helps to prevent osteoporosis
Levin VA, Jiang X, Kagan R. Estrogen therapy for osteoporosis in the modern era. Osteoporosis International. 2018 May; 29 (5): 1049-1055.
HRT is associated with a 34% reduction in risk of vertebral fracture, a 29% reduction in hip fracture and a 21% reduction in non-vertebral fracture when compared with placebo.
Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008;107(1);102–11. doi: 10.1007/s10549-007-9523-x.
Transdermal oestrogen with micronised progesterone (Utrogestan) can lower blood pressure
Issa Z, Seely EW, Rahme M, El-Hajj Fuleihan G. Effects of hormone therapy on blood pressure. Menopause. 2015 Apr;22(4):456-68.
Taking HRT can lower future risk of heart disease, diabetes, dementia and osteoporosis
Manson JE, Aragaki AK, Rossouw JE et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA. 2017; 318(10):927-938
Commencing HRT within 10 years of menopause (or before the age of 60), reduces the risk of coronary heart disease by 48%.
Boardman HMP, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2015;(3):CD002229. doi: 10.1002/14651858.CD002229.pub4.
No difference in all-cause mortality with HRT (lower all-cause mortality in women 50–59 years taking HRT)
Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal hormone therapy and long-term all-cause and cause-specific mortality: The Women’s Health Initiative randomized trials. JAMA 2017;318(10):927–38. doi:10.1001/jama.2017.11217.
Women with lupus who take HRT (transdermal estrogen & micronised progesterone) do not increase their risk of clot further, and often experience significant benefits to their quality of life and future health.
Gompel A. Systemic lupus erythematosus and menopause. Climacteric. 2020 Apr; 23 (2): 109- 115.
Bio-identical HRT
Unlike body-identical HRT, the effectiveness of these products has not been proven and their use is associated with potential risks.
The production of bio-identical products is not subject to the regulatory conditions of approved pharmaceutical products
Files JA, Ko MG, Pruthi S. Bioidentical hormone therapy. Mayo Clin Proc. 2011;86(7):673-80.
Inadequate progesterone (endometrium protection) and the risk of endometrial cancer
Eden JA, Hacker NF, Fortune M. Three cases of endometrial cancer associated with "bioidentical" hormone replacement therapy. Med J Aust. 2007;187(4):244-5.
Davis R, Batur P, Thacker HL. Risks and effectiveness of compounded bioidentical hormone therapy: a case series. Journal of Women's Health. 2014;23(8):642-8.
Issues related to unregulation and contamination of compounded products.
Santoro N, Braunstein GD, Butts CL, Martin KA, McDermott M, Pinkerton JV. Compounded bioidentical hormones in endocrinology practice: an Endocrine Society Scientific Statement. J Clin Endocrinol Metab. 2016;101(4):1318-43.
Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, Duwve J, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369(17):1598-609.
Poon WT, Lam YH, Lee HHC, Ching CK, Chan WT, Chan SS, et al. Outbreak of hypoglycaemia: sexual enhancement products containing oral hypoglycaemic agent. Hong Kong Medical Journal. 2009;15(3):196-200.