Hormone Replacement Therapy (HRT)
Hormone replacement therapy - HRT - is the use of oestrogen, or oestrogen + progestogen to control symptoms that may occur at the menopause ('change of life'), for example hot flushes, sweats and vaginal dryness
HRT was the most effective treatment for hot flushes and other menopausal symptoms in the early 2000s but some medical research began to suggest that it caused harm and people's attitudes to HRT changed. However this medical research has recently been reviewed and “Most experts agree that if HRT is used on a short-term basis (no more than five years), the benefits outweigh the risks” (NHS Choices 2014).
As with any medication, HRT has benefits and risks and these should be discussed with your doctor as it may not be suitable for everyone. HRT is not recommended for women who:
- have a history of breast cancer, ovarian cancer or womb (uterus) cancer
- have a history of blood clots
- have a history of heart disease or stroke
- have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
- have liver disease
- are pregnant
Several women we spoke with were wary of media reports about HRT and breast cancer and had discussed the pros and cons with their doctors.
Some women were taking or had been taking HRT to relieve menopausal symptoms or to protect against osteoporosis. Several talked about its benefits for menopausal symptoms and recommended it to others, though some had gained weight whilst taking it. One woman had taken HRT for ten years and said it had helped with her day and night sweats. A nurse who had used HRT for some years said that, for her, the low risk of getting breast cancer was outweighed by the benefits of taking HRT. Another woman, whose mother had died of breast cancer, said her GP emphasised the importance of attending for breast screening because of the risks of HRT. She stopped taking HRT for a while but felt 'miserable' off it and asked to take it again. One woman had depression and panic attacks during her menopause, which went away with HRT. She was now scared of stopping it.
- Age at interview:
- Is retired, married with 1 adult child.
So do you get the HRT from the GP every 6 months?
Yes, yes, oh yes.
And has it been good for you?
Yes, excellent, first time around. It makes you a different person [laughing].
Can you explain that a bit more?
Well, night sweats, terrible. And the day sweats, well from one minute to the next it can change. Once you're boiling hot and it could be freezing cold outside, then I'm cold, then I'm hot and cold and on. Night sweats, it's so uncomfortable, changing all the time. Well I didn't, I wasn't that bad so my clothes weren't soaked but it's so uncomfortable. It doesn't last long but very uncomfortable. But then I mentioned it at the surgery and they saw me. They said "yes, we'll have a check-up, see if things are all right." Thank God, I haven't had any problems with it. It's just wonderful.
- Age at interview:
- A retired clinic clerk and receptionist. Married with 4 adult children.
I've had a few now [mammograms] because I've been on HRT for fourteen years now and because my mother died a few years back with breast cancer and I have quite a bit of cancer in our family, my GP decided that she'd like me to go up to the Hospital and get checked again at some stage so that she could either continue or discontinue my HRT which I'm very happy to be on.
Do you have any concerns about that or have you always been happy with it?
I went on HRT early because in my early 40s I had to have a total hysterectomy so I was on it early. And I was taken off it short term for a while, the doctor tried but I was quite miserable and short tempered and so I asked her to put me back on and that's why she wants me to be careful with my screening because I've been on it rather a long time now. But I think it's a wonderful thing.
- Age at interview:
- A retired widower with 3 adult children.
I've been on it [HRT] eight years now and I'm too scared to come off it now [laughs]. I must admit I am on the dual one as well which of course I get a bleed but the thing is I don't want to come off it because basically I'm quite healthy and I don't know what I'd be like off it. And because depression was one of the things I had during my menopause, very low, very weepy and I feel so, a lot better on it although I put weight on. But I am quite happy on it. I don't know how long I can stay on it.
And I got to the stage where I was crying, you know. The children were at home then, the kids were at home and I must have been in my late forties when I started my change, under fifty. And I was getting to the stage where everything, if I dropped something I'd burst into tears and they all sat one Sunday lunch and said "what's wrong with you", you know and I just said "I don't know".
It wasn't so much, I do, I did get the hot flushes but it was the, I got panic attacks as well. I stopped driving, I had terrible panic attacks, I couldn't drive, in fact I don't drive still. And I got dreadful, I couldn't go out the house. I got terrible panic attacks and in the end I went back to the GP and she, a few years later, I don't know how long after, well it must be, anyway it was still that first practice and she put me on it. And I've never looked back since.
So, while you were having these symptoms were you able to talk to anybody or did you feel isolated or were there people you could talk to, other women or?
I don't think I did that, you just go through it I think, you know. You just talk to yourself and try and pull yourself together but it's very hard when you can't describe to someone why you cry and why you feel fed up and why you get these sudden horrible panic attacks where you don't want to do anything. But I mean I don't have anything like that now, and that's why I'm staying on it.
Several women had been on HRT but were no longer taking it. Some stopped taking it when the menopause ended. One said her consultant felt the cysts she'd had in the past might have been caused by HRT. She was no longer taking HRT and said she could live with the mild hot flushes she occasionally had. Another woman stopped taking HRT after 18 months because her blood pressure had risen. After a year on HRT, one woman tried a herbal treatment which worked just as well without causing weight gain. She preferred Wild Yam Root to HRT, and recommended it to other women.
- Age at interview:
- A full-time writer. Married with 2 adult children.
He related it [cysts] to Hormone Replacement Therapy and said it is very common with that, which I didn't know. I've been on it for 10 years and hadn't really worried about it.
So when did you start the HRT? When you were about ...?
When I was 45 and I've just come off it.
And how do you feel now?
Absolutely wonderful and half a stone lighter [laughing].
So when you went on the HRT were there symptoms that you were having, menopausal symptoms, hot flushes...?
Yes, yes, yes.
And how did the HRT help?
Well, it didn't stop the hot flushes but I had various other funny symptoms, which it did control. Yes, it was good while I was on it and then my doctor said to me a few weeks ago, "you've been on it 10 years, it's time you thought about life without it. And you should be through all that by now anyway." So, I never got rid of the hot flushes while I was on it and I still get the hot flushes now but I'm so used to them, so I don't worry about it.
- Age at interview:
- A retired NHS secretary. Divorced wtih 2 adult children.
I went through menopause at about 50. A few hot flushes, nothing particular to worry about. But then I read a booklet by the Amarint Trust about the benefits of HRT and asked the GP if I could go on it. Not because of the hot flushes bothering me, but just because it sounded like a good idea for your general health. That was post menopause. I'd had been, my menopause was almost passed when I went onto HRT.
And he explained that it was something that you could have if you asked for it. But the NHS couldn't afford it for everybody. So I was expecting to have a battle with the GP about whether I was to go on it or not. But he was fine about it and just said "yes, if you think it's a good idea, fine".
So I started on it and he tested my blood pressure every, I think it was about every three months. And gradually, it was alright to begin with, but gradually the blood pressure went up and up. So after about 18 months he suggested I came off it, so I did.
- Age at interview:
- Retired Marks and Spencer PA. Married with 2 adult children.
So, when you went on the HRT, were you having certain symptoms and that's why you went to the doctor, what symptoms were they?
Oh yes, terrible flushes but I was only about 45, I think, when it started. And I was having pains in my legs, I was feeling quite tired and quite down and then I went on to HRT, which I didn't really want to do but it really helped. And then after a year of taking HRT I decided to take a herbal remedy which is called Wild Yam Root which really helped me and I stopped taking HRT after that, yes.
I mean I've seen myself that the herbal extract works because I stopped taking HRT and I took this and it worked for me. And I presume there aren't, I don't think there are any side-effects but, hopefully, there isn't. But whereas when you take conventional medicines there always seems to be a list of other side-effects and I don't want those.
Do you ever advise other women who you know that are taking HRT to try the herbal one?
Yes, I do always. And in fact my other sister-in-law rang me the other day because she wanted to stop HRT and asked me where to buy this.
Did it work equally as well as the HRT?
Yes it did, yes it did. And in fact, I stopped HRT and the reason I started this Wild Yam was because I was putting on a lot of weight and it was all kind of a water retention weight. I mean I didn't look overly fat but I just felt very heavy and when I stopped HRT, I hope you don't mind me saying this, but I just did not stop going to the toilet for days and days, it was just continuous. So I had all this water retention and I never did get that with the herbal extract, so that's one of the reasons I was looking for something else. And I did actually ...
So your stomach always felt a bit bloated?
Yes, and my legs. I was, in fact I looked quite bloated most of the time.
- Age at interview:
- Delfina is a housewife. She is married with one adult son. Ethnic background/nationality: Italian.
Have you always felt that you have got all the information you need about breast screening or sometimes when you have gone have you ever asked questions about either the process?
No unfortunately I never did. I should like to know more. Because I was like, I was on HRT and they say, when I started taking it, it was because I was going through the hot flushes. It was really horrible. Really very heavy. I didn't want to take it, because I don't really like to take anything. If I can avoid a tablet, I will avoid it. You know, it is not. It is just you know, but then I decided to take it because my heart surgeon advised me it was good for the heart. But then I read a couple of years later, when I was taking it, that it was perhaps not so good for the breast actually. You know, it was completely opposite of what I was told. But I did carry on taking it and I stopped this year. Just without having consulted the doctor, because I forgot when I went on holiday to take the tablets, so it was a good excuse to stop taking it. And my doctor then said, you have got to stop because I was taking it for the last seven years now, seven or eight years, so he said not to be take it over five years, because of the breast cancer things.
So you were taking HRT but when you went on holiday you forgot to take it with you and just stopped after that?
Yes. I could have taken it after ten days because my husband brought them to me [in Italy], but I already consulted the doctor because I didn't know actually if I could stop or just like now and then, or you have to go gradually, you know, changing to a smaller dosage. But the doctor there said it was not side effects, are you having side effects, so…
And he said it was fine to just stop them?
To just stop that, that is what he said and I haven't seen my doctor here [in England] to let him know that I did stop. When I get to see him I will mention it to him. I did stop, you know, because I got a little bit more heat raise here and there but not so bad that I can't go on with it.
So nothing like you were getting, the hot flushes, nothing like that after you stopped HRT?
No perhaps, you know, sometimes I get a little bit of heat. Perhaps I am working really hard in the house, like hoovering, but not something I cannot handle. I am glad about going through the change and they stop.
So you were getting hot flushes around the age of 50 or… later?
I was feeling bad you know, bad really, I recall I was, I went on holiday and I couldn't even cook. I couldn't cook, I had to have a towel next to me. I mean it was unbearable for me. Because some people have hot flushes and they don't sweat that much. That year was really, really bad. That was what made me do it, because otherwise I don't think I would have just take them. But there was a good dosage, they were good for me, because I never had any side effects, I never changed it. It changed my life not for better, not for worse, it just subsided the hot flushes. But it was all right, I didn't put on weight. People think, you know, you put on weight. My life didn't change at all. You know, just my every day feel, you know in my body or side effects, none at all. Just help the hot flushes a lot.
Yes. Made them much less?
Oh yes, definitely, much less.
And did you ever talk to your heart surgeon or any of the doctors about the HRT because they mentioned th
A few women who'd had breast cancer wondered if HRT had caused it, and one said she needed to blame her cancer on something and put it down to HRT. Another wondered whether stress had played a role. One woman, who'd had an early form of breast cancer (Ductal carcinoma in situ or DCIS), had stopped taking HRT for osteoporosis and wondered if this had eliminated her risk of getting DCIS again, which HRT might have caused. She had since been prescribed calcium tablets for her bones and wondered why she hadn't been prescribed these earlier as doctors knew that HRT carried a breast cancer risk.
- Age at interview:
- A retired secretary. Married with 3 adult children.
I was taking HRT, and I do think it was that. Nobody will confirm it of course, but I do believe it.
How long had you been on the HRT?
I'd been on it a few years. It might have even been going on for five, I don't know. I used to go every three months, or six months, to see the HRT doctor. I saw her a few weeks before I was diagnosed with cancer, and she didn't know even though she'd examined me.
She'd examined your breasts every time?
Yes I think she did. I can't remember to be honest, because it's a while ago now, but I did go every three or six months to the HRT doctor. Not at my practice, that was somewhere else. But I do believe it was the HRT, yes.
Did she ever examine your breasts at all, while you were on HRT?
Did you examine them yourself?
No, just looked, basically, yes. But knowing what I know now, I wouldn't have gone on HRT. It took me a while to - I only went on it because she said my bones were sort of 50-50. (It took me nine months to decide), and we all believe that HRT caused the cancer. My daughters think that as well. I don't suppose they'll go on it.
- Age at interview:
- A secretary, married, with 2 adult children.
I think it's been helpful to me, I think it's helpful to most women if they can blame it [breast cancer] on something. And I went on to, I went through quite an early menopause and was having problems and my doctor, I actually went to my doctor and asked if I could be put onto HRT. A friend of mine, work colleague again and friends, had been, they were on HRT and they were saying it was fantastic, they felt amazing, they weren't getting the mood swings which I was getting, and the hot flushes, you know, and irregular periods whatever.
And I went to my doctor, my own GP, and he was very good. He talked me through the pros and the cons, and said he wasn't too keen on me going onto HRT, and he did say that it caused, there was a risk of breast cancer. And it was just, I took on board for a while, but then I came away and the mood swings started again, and irregular periods, whatever.
And there again, my work colleagues and friends were saying, "Go onto HRT, you have a right to go on it." And "Sure, it's fantastic, there's only a very small risk for breast cancer." So I went back to him again, and he really wasn't too keen on prescribing the HRT. So that was twice, so a third time I thought, I don't care what he says, I want HRT. So when I went to see him he was on holiday, and it was a locum GP and she didn't hesitate and she put me on HRT right away.
So I was on HRT for I think just coming up to three years, yeah, just yes, just coming up to three years. When I was diagnosed with breast cancer I was told immediately to stop taking HRT. So I thought, well bearing in mind my lifestyle, and I don't smoke and you know, I thought, it must be the HRT. So [sighs] it helped me being able to blame the breast cancer on something, so I blamed the HRT. It mightn't have been that. My surgeon and another doctor did say that three years wouldn't be a long enough time to cause breast cancer on HRT but who knows, you know?
All the women who took HRT and were later found to have breast cancer were advised to stop taking it after their diagnosis. Most did not take HRT again, but one asked to go back onto HRT because it greatly improved her quality of life, and her doctors agreed. Another, who'd had Paget's disease (a rare cancer of the nipple) and DCIS, said that she'd been prescribed HRT for five years without really being monitored until she changed GP. Her new GP suggested she come off HRT.
- Age at interview:
- A child protection officer. Divorced.
And I asked a lot of questions by then and one of my main concerns wasn't about the fact that I'd had a breast removed but whether I could go back on HRT because I felt that my quality of life was more important.
And it was agreed that she [nurse] would speak to the consultant. He came to speak with me and I felt I needed to put this point across that I would like a reason why I should not return on to the HRT. What he did say was he would have to have a meeting with other colleagues before they made a decision. And their decision was that I could return to the HRT because there was no factors to indicate it was receptive to the hormones.
When you, before you had the mastectomy, you were talking to the consultant about having a mastectomy, is this when the conversation came up about you will have to stop the HRT patches?
Yes, yes. He was very, he was very against it. And I had looked up a bit about it anyway prior to all this, and I was feeling so well on HRT and have done for many years that, I really didn't want, I didn't want to go back to what it would have been like without them. And I certainly wouldn't have wanted to return to my employment having suffered menopausal symptoms. So it was something that I felt I would probably fight about, and I did.
So after the mastectomy, how soon after where you able to take the, have the patches?
I would say about a week after I returned home. And my GP was a bit unhappy about it, but there was a letter to support what I'd said, so that was fine.
Yes, so you were back on it?
I was back on them fine, yes.
- Age at interview:
- A physiotherapist assistant. Married, with 2 adult children.
And how long had you been taking the HRT?
About five years. So, without, you know, really thinking about it I suppose.
So, you went to the GP every six months to get HRT?
And what kind of questions did he or she ask you?
He didn't ask me any questions at all. I had no check ups at all while I was on the HRT. I mean I just had repeat prescriptions and I would just go and pick them up. It wasn't until I changed to the female doctor, who is the best doctor at the practice anyway, I think, and she said to me "I don't think you should to take the HRT anymore" and by which time we both come to the conclusion that I would come of it, so...
Some people had chosen not to take HRT, despite it being recommended by other women. One woman whose mother had had osteoporosis refused to take HRT because its long-term effects were uncertain. A few others said they would like more information about HRT and its long-term effects.
- Age at interview:
- A housewife, married with no children.
You were reading the book 'the myths of the menopause'. You never had any menopausal symptoms. What, did this book reaffirm that kind of thing?
It told me quite a bit about HRT because when my mother was alive she kept saying ' Have you started, are you going through the menopause yet?' 'Oh go on HRT.' "Mum! There's nothing wrong with me!" And HRT to me is more of a problem, I think it's just, it was an American doctor who discovered it and they've given it people for years and years and years. They don't know the long term affects of it. It's just like the pill, what they don't know but they can certainly shut women up by putting them on it. And that is not a good thing.
And my mother had osteoporosis so my GP, I go to, mine's a lady and she did mention HRT once and I said, for osteoporosis, and I said you know "I'm not going on HRT, you can put me on Didronel [calcium tablets]" [laughs] so that was sort of it, you know, I wouldn't have gone on it. But I didn't need to. So...
See more experiences of hormone replacement therapy (HRT).
Last reviewed March 2016.
Last updated March 2016.