Fact vs. Fiction In Hormone Replacement Therapy: Common Myths Debunked

Whether it be through friends, family or social media platforms, hormone replacement therapy (HRT) is often associated with various rumours, half-truths and misconceptions. This can make it hard for you, as a patient, to know what to believe. In this article, we speak to Ms Claudine Domoney — a Consultant Obstetrician and Gynaecologist here at OneWelbeck — to separate the fact from the fiction once and for all, and discuss the true advantages and disadvantages of having HRT.

What is hormone replacement therapy (HRT)?

Before we get started, it’s important to first take a detailed look at what hormone replacement therapy (HRT) actually is in terms of how it’s used and who it’s recommended for.

In simple terms, HRT is a medical treatment commonly used to address hormonal imbalances in our bodies.

Throughout our lives, the hormones that our bodies contain help regulate a wide range of essential bodily functions, including our metabolism and mood. But, as we get older, these levels can fluctuate, leading to various symptoms and potential health issues.

For this reason, HRT is most commonly recommended for women going through menopause — a natural part of the ageing process brought on by declining levels of oestrogen and progesterone.

However, HRT may also be recommended for men experiencing low levels of testosterone (andropause) and individuals with certain medical conditions or lifestyle factors that can result in hormonal imbalances.

The benefits of HRT

For people with hormonal imbalances, HRT can offer several important benefits — especially in terms of alleviating any associated symptoms.

In women experiencing menopause, for example, HRT can be a highly effective method of reducing symptoms like hot flushes, vaginal dryness and mood swings, leading to huge improvements in quality of life.

Likewise, for men with low testosterone, HRT has been shown to increase energy levels, improve muscle mass and lead to an overall enhanced sense of well-being.

Certain studies have even found that HRT can reduce the risk of developing medical conditions like osteoporosis and heart disease due to its positive impact on bone density and cholesterol levels.

HRT: common myths debunked

HRT’s association with various myths and misconceptions makes it crucial to double-check any facts as and when you hear them, according to Ms Domoney.

“Myths can come from family, friends, newspapers, social media and, more concerningly, other healthcare professionals,” she said. “If you hear one that doesn’t make sense, question its logic and check its source to make sure it’s reliable.”

With this in mind, we’ve broken down some of the most common myths associated with HRT, separating fact from fiction using Ms Domoney’s expert insight and guidance.

HRT causes cancer

While HRT can carry various risks and complications, the relationship between its use and cancer is a lot more subtle.

A major study conducted by the Women’s Health Initiative (WHI), for example, found that certain HRT formulations, particularly those containing progestins, were associated with an increased risk of breast cancer.

However, Ms Domoney believes that these results have been blown out of context and aren’t necessarily a cause for concern.

“Many of the participants included [in the WHI’s study] were a lot older and not in good health, and its results aren’t really relevant or reflective of the European population.”

Instead, she believes having an elevated risk of cancer due to HRT really depends on the health of the individual patient.

“If you have a body mass index higher than 30, or use combined HRT treatments for a long period, this can increase your risk of developing breast cancer over time. However, if you keep yourself fit and healthy, prescribing HRT can offer a lot of benefits.”

HRT causes blood clots

The link between blood clots and HRT really depends on the mode of delivery.

A study published in the British Medical Journal back in 2019, for example, reported that there was a 58% increased risk of developing blood clots due to HRT. However, this was specifically associated with HRT tablets, rather than gels or patches.

“There's only a very small increased risk of a blood clot when taking oestrogen through the skin, which is why we tend to use gels or patches for most women,” according to Ms Domoney.

However, even with the increased risk of blood clots with HRT tablets specifically, Ms Domoney says there are certain situations where they may be recommended.

“Patients can take HRT tablets as long as they haven't got any other contraindications. If they don’t have an increased thrombotic risk or high blood pressure, they can be a very reasonable treatment option.”

HRT cannot be used long-term

Another commonly shared misconception is that HRT is not suitable for long-term use. However, according to Ms Domoney, this isn’t strictly true — especially when using HRT as a treatment for menopausal women.

“The length of time that HRT can be taken is determined by the wishes of the woman, the age at which she started taking it and her reasons for needing it,” she said.

“There are no set times for how long it can be taken. Each decision should be carefully considered by herself and a healthcare professional with an understanding of prescribing treatments for menopause.”

The importance of a personalised HRT plan

Every patient is different and, unfortunately, there is no one-size-fits-all approach to deciding to start HRT.

Your treatment needs will vary depending on factors like your age, overall health, medical history and the cause behind your hormonal imbalance. That’s why having a personalised treatment plan is so important — for both patients and healthcare professionals.

“Tailored treatment allows us as practitioners to understand and listen to patients’ individual needs,” Ms Domoney said.

“When dealing with nervous patients, for instance, I will often start by prescribing low doses of oestrogen to make them feel more comfortable and allow them to gradually find a dose that suits them. If they want to stop or tweak it a little bit, that’s absolutely fine.”

To find out more about starting a personalised HRT treatment plan with us at OneWelbeck, simply contact our team and we’d be more than happy to help.

Hormone Replacement Therapy Specialists

We have brought together a group of leading gynaecologists and breast specialists to form our Women’s Health team. With over 200 years of combined experience, these expert clinicians are the best in their field and are all focused on delivering the very best patient care.