HRT side effects: risks of hormone replacement therapy - and is it linked to dementia and breast cancer?

Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause.

It works by replacing hormones that are at a lower level as you approach the menopause.

But what are the side effects, is there a risk of breast cancer and dementia, and what are the benefits of the treatment?

Here’s what you need to know.

What is HRT?

HRT is a treatment used to relieve symptoms of the menopause.

Hormone expert Dr Shirin Lakhani explains that HRT “is designed to replace the female sex hormones that naturally decline over a period of time during the menopause”.

Online GP service Push Doctor notes that when you begin to go through menopause “your levels of estrogen and progesterone decrease as your ovaries stop making enough of them”.

HRT is then used at this stage to help replace these, which then eases symptoms and any discomfort that is likely to occur.

HRT comes in a number of different forms, including tablets, patches and gels.

Vaginal oestrogen tablets - a type of HRT - could also soon be available in chemists, depending on the outcome of a consultation.

Under new proposals, women would be able to get them without a prescription instead of going to see their GP.

What are the benefits of HRT?

According to the NHS website, the main benefit of HRT is that it can help relieve most of the menopausal symptoms, such as:

• hot flushes
• night sweats
• mood swings
• vaginal dryness
• reduced sex drive

“Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women,” notes the NHS.

The treatments can also help prevent weakening of the bones (osteoporosis), which is more common after menopause.

What are the side effects of HRT?

HRT can cause side effects. But these will usually pass within 3 months of starting treatment.

Common side effects include:

• breast tenderness
• headaches
• feeling sick
• indigestion
• abdominal (tummy) pain
• vaginal bleeding

What are the risks of HRT?

The NHS explains that some types of HRT can increase your risk of breast cancer.

There is little or no change in the risk of breast cancer if you take oestrogen-only HRT, but combined HRT can be associated with a small increase in the risk of breast cancer.

The increased risk is related to how long you take HRT, and it falls after you stop taking it.

Due to the risk of breast cancer, it’s important to attend all your breast cancer screening appointments if you’re taking HRT.

Dr Giuseppe Aragona, GP and online doctor for Prescription Doctor, explains that for a lot of women “the benefits of HRT will outweigh the risks”.

However, he notes that you should always consult your GP if you have any concerns or queries concerning HRT.

Dr Lakhani notes that although “we tend to suggest that women do stop taking HRT after around five years because the risk of breast cancer does increase after this time,” the advice from NICE, which she agrees with, is that “women shouldn’t be advised

to stop taking HRT after any arbitrary time limit”.

“An individualised approach is vital and the decision to stop taking HRT needs to come from a balanced discussion with a practitioner who has specialist knowledge in the field,” adds Dr Lakhani.

A recent study has also found that HRT is not linked to an increased risk of developing dementia.

Researchers at the University of Oxford, Southampton and Nottingham investigated the risks of developing dementia for women using any of the forms of HRT commonly prescribed within the NHS.

Their study, which involved more than 600,000 women over three decades, concluded that HRT is not linked to an increased risk of dementia.

Regarding HRT and dementia, Dr Lakhani notes that “‘if started early enough, HRT can protect against heart disease and dementia”.