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HRT Side Effects and Risks

If you are experiencing unbearable menopause symptoms, you might be considering talking to your GP about starting hormone replacement therapy (HRT). Or maybe you’ve been taking HRT for a little while now, and you want a refresher on the possible side effects and risks.

That’s what we’re looking at in this article. It’s important to discuss any side effects and risks with your GP before starting a course of treatment to make sure you know all the implications. Although HRT can be hugely beneficial to women suffering with severe perimenopause symptoms, it isn’t without risks.

(By the way - if you want to learn more about menopause before reading this, you should take a look at our article What Is Menopause?)

HRT Side Effects

HRT can cause side effects, as any medication can. With HRT, however, you should find that the side effects pass within 3 months of starting the treatment. If your side effects don’t pass in 3 months or they are particularly severe, you should speak to your GP.

The main side effects of taking oestrogen include:

  • Bloating

  • Vaginal bleeding

  • Breast tenderness or swelling

  • Swelling elsewhere on the body

  • Nausea

  • Indigestion

  • Leg cramps

  • Headaches

The main side effects of taking progestogen include:

  • Breast tenderness

  • Vaginal bleeding

  • Swelling

  • Headaches / migraines

  • Mood swings

  • Depression

  • Acne

  • Abdominal pain

  • Back pain

If you find your side effects are particularly bad on one method of HRT (ie tablets, patches, implant, gel), your doctor might switch you to another to see if that helps.

Weight gain has long been considered a side effect of HRT, but there’s no evidence to support this. Many women gain weight during perimenopause, and this would happen whether you took HRT or not. Eating a healthy diet and exercising regularly will help you lose excess weight and can also be beneficial for managing signs of menopause.

HRT Risks

As well as the possible side effects, HRT can increase your risk of developing certain types of cancer and other illnesses. However the National Institute for Health and Care Excellence (NICE) considers the risks small enough to be outweighed by the positives.

To summarise, there is a slightly increased risk with the following conditions:

  • Breast cancer: Combined HRT (which includes estrogen and progestogen, synthetic versions of both the female hormones) causes a small increase to the risk of breast cancer, but this decreases again when HRT is stopped. There is no increase if you’re taking oestrogen-only HRT.

  • Ovarian cancer: Studies into the risk of ovarian cancer when taking HRT have been contradictory. It is believed that if there is any increase in the risk, it is minimal and decreases again when you stop using HRT.

  • Womb cancer: Oestrogen-only HRT is known to increase the risk of womb cancer. For this reason it is only used in women without a womb (eg women who have had a hysterectomy), or prescribed alongside a progestogen. Combined HRT doesn’t have this same increased risk.

  • Blood clots: Taking HRT in the form of tablets can increase your chance of developing a blood clot, whereas using HRT patches and gels doesn’t. However the overall risk from taking HRT tablets is very small.

  • Heart disease / stroke: In general, HRT doesn’t have any affect on your risk of cardiovascular disease. Oestrogen tablets are associated with a small increase in stroke. Since the risk of women under 60 having a stroke is very low anyway, it remains low even when taking HRT tablets.

You can read more about the risks associated with HRT here. Make sure you have regular appointments with your GP so they can monitor your health when using HRT and attend any screening appointments you are offered too.