Benefits and risks of HRT

NICE looked at the risks of the following conditions in women taking HRT compared with women of menopausal age in the general population. Your GP should explain that the risks of the conditions described below vary from one woman to another and depend on many risk factors. In cases where HRT is said to increase risk this usually means a very small increase in most women.

More information about this is available in section 1.5 of the version of the guideline for healthcare professionals.

Blood clots (venous thromboembolism)

HRT tablets (but not patches or gels) are linked with a higher risk of developing a blood clot.

If you are already at higher risk of blood clots (for example, you are obese) and you are considering HRT, you may be offered patches or gel rather than tablets.

If you have a strong family history of blood clots or if there's another reason why you are at high risk of blood clots, you may be referred to a haematologist (a doctor who specialises in blood conditions) before considering HRT.

Heart disease and stroke (cardiovascular disease)

Studies show that:

  • If you start HRT before you're 60 it does not increase your risk of cardiovascular disease.

  • HRT does not affect your risk of dying from cardiovascular disease.

  • HRT tablets (but not patches or gels) slightly raise the risk of stroke. However, it is important to remember that the risk of stroke in women under 60 is very low.

If you're already at higher risk of cardiovascular disease it may still be possible for you to take HRT but it will depend on your individual circumstances. Your GP can give you more information.

Breast cancer

Studies show that for women around menopausal age:

  • Oestrogen‑only HRT causes little or no change in the risk of breast cancer.

  • HRT that contains oestrogen and progestogen may increase breast cancer risk. This risk may be higher if you take HRT for longer but falls again when you stop taking HRT.

Type 2 diabetes

HRT does not increase your risk of developing type 2 diabetes.

If you already have type 2 diabetes, HRT is unlikely to have a negative effect on your blood sugar control. When deciding if HRT is suitable for you, your GP should take into account any health problems related to your diabetes and may ask a specialist for advice before offering you HRT.

Osteoporosis

When your ovaries stop making oestrogen your bones become thinner and you have a higher risk of osteoporosis, where your bones break more easily.

You should be given advice about bone health and osteoporosis at your first appointment and again when reviewing your treatment. Your GP should explain that for women around menopausal age the risk of breaking a bone is low, and HRT reduces this risk further. This benefit only lasts while you are taking HRT but it may last longer if you have taken HRT for a long time.

NICE has produced advice about fragility fractures in osteoporosis. See other NICE guidance for details.

Loss of muscle strength

You may lose muscle strength as you reach menopause, and HRT may improve this. However, it is also important to carry on with daily activities and exercise, which will help you to stay as strong and fit as possible.

Dementia

It is currently unknown whether HRT affects the risk of developing dementia. NICE has recommended more research about this.

  • Information Standard