What Are The Side Effects of Hormone Replacement Therapy (HRT)?

What is HRT and why is it prescribed?

Hormone replacement therapy (HRT) generally refers to estrogen and/or progesterone replacement for women, usually around the time of menopause. It has been widely used since the 1960s to reduce menopause-related symptoms like hot flashes, night sweats, vaginal dryness, and mood swings. 

Types of hormone replacement therapy

In HRT for menopause symptoms, estrogen-only based as well as estrogen plus progesterone-containing medication regimens are generally used. 

Estrogen only HRT

Estrogen-only medications are usually used for women who have had a hysterectomy (uterus removal). This is because unopposed estrogen (estrogen with no progesterone) has been shown to increase the risk of overgrowth of the uterine lining called the endometrium. This increases the risk of cancer of the uterus. 

Combined HRT

Combined estrogen and progesterone medication regimens are usually used for women who still have their uterus in order to protect the uterus against endometrial cancer that using estrogen alone can cause. The progesterone helps the uterus to shed the endometrial lining of the uterus to prevent overgrowth and thus reduce cancer risk.

Topical and local HRT

Localized hormone therapy can also be used, and it usually comes in the form of an estrogen-only vaginal cream, vaginal tablet, or ring. These medications generally have lower risks of side effects since the hormones are at lower levels or stay in the area they are placed in the case of creams, gels and rings. 

Common side effects of HRT

Hormone-based medications do come with some side effects and risks. These include both short-term and more serious side effects and risks.

Short-term side effects 

• Breast tenderness

• Nausea

• Bloating

• Headaches

• Acne

• Rashes

More serious side effects 

• Increased risk of blood clots

• Liver function issues

• Weight gain

• Increased risk of breast cancer (particularly in combined HRT)

• Increased risk of heart disease

Health and lifestyle factors that affect HRT side effects

Your overall health and family history will impact how you respond to HRT and if you are at a higher risk of things like cancer. 

• Cardiovascular disease: People with a history of cardiovascular disease like high blood pressure or blood clots will have a higher risk of having a stroke or blood clot while on HRT. 

• Cancer: If you have a family history of hormone-sensitive cancers like breast or ovarian cancer, you might also have a higher risk of cancer from HRT. 

• Liver problems: People with liver issues might not metabolize hormones the same way that people with healthy livers do, which can also lead to worse side effects. Smoking and alcohol consumption can also affect how the liver processes hormones.

• Age: People who start HRT closer to the start of their menopause will generally have less side effects than people who start HRT later.

• Obesity: Obesity can make side effects like cardiovascular disease and stroke more likely.

• Smoking: Smoking also increases the cardiovascular side effects of HRT. It is generally recommended to quit smoking before starting HRT.

• Sedentary lifestyle: Being sedentary (not moving or exercising much) can make weight gain and blood clots more likely while you’re on HRT. 

The theme here is that if you have any health concerns or a family history of health issues, let your doctor know so that they can be taken into account when making decisions about hormone replacement therapy. 

Managing and reducing side effects of hormone replacement therapy

The key to managing or reducing side effects of HRT is to personalize the treatment plan to each individual based on their personal and family history, as well as any lifestyle factors like smoking or obesity. Choosing the right type of treatment, and the right delivery method (pills, gels, patches etc), can make a big difference in how your body will respond to the hormones.

 For example, the patch has been shown to cause less blood clotting issues compared with the pills, making it a possible safer choice for those at risk of blood clots. 

Start with the low dose recommended by your doctor, and follow their lead when it comes to increasing it to allow your body to adjust to hormonal changes. This will minimize some of the side effects like breast tenderness and nausea. 

Finally, make sure to have regular follow ups with your doctor to ensure the treatment is working well and that you don’t have any issues. Working closely with your health care professional, any concerns can be addressed quickly and will make it more likely that you’ll have a positive experience with HRT.