Hormone replacement therapy (HRT) can help relieve menopause symptoms. Some potential risks include blood clots or an increased risk of certain cancers, but doctors will explain these risks before prescribing HRT.

HRT is a medication that provides certain hormones to the body. People may take HRT for menopause or as gender-affirming hormone therapy.

This article looks at the uses of HRT and the short- and long-term risks of HRT.

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According to a 2021 review article, estrogen is the most effective treatment for menopausal symptoms such as hot flashes and night sweats.

The article’s authors also state that the risks of HRT for menopause may depend on a person’s age and the time between menopause onset and starting HRT.

Potential risks of HRT include:

If people take HRT before age 60 or within 10 years of starting menopause and are in good health, the risks are typically low. Therefore, the benefits of treatment often outweigh the risks.

That said, while oral HRT has links to an increased risk of blood clots, HRT via skin administration, such as using gels or patches, does not appear to have an increased risk.

Cancer risk can depend on any history of hormone-dependent cancers, such as breast cancer, and the type of HRT formulation people are taking.

According to the United Kingdom’s National Health Service (NHS), short-term side effects of HRT may depend on the type of hormone but may include:

However, these side effects are usually temporary and may resolve within a few weeks.

Using combined HRT, which is a combination of estrogen and progesterone, increases the risk of breast cancer, with a higher risk of the disease for at least a decade after stopping HRT.

Estrogen-only HRT increases the risk of endometrial cancer. This is only for people who no longer have a uterus. People with a uterus will have to take combined HRT.

Experts advise against using systemic HRT, in which a person’s whole body absorbs the treatment, in people with breast cancer or a history of breast cancer.

Transgender people may take feminizing or masculinizing hormones to align physical characteristics to their gender identity. This treatment is known as gender-affirming hormone therapy (GAHT), which may help treat gender dysphoria.

Feminizing hormones include estrogen, progesterone, and anti-androgens. Masculinizing hormones include testosterone.

According to a 2022 review, which looked at 53 articles, limited evidence suggests GAHT may increase the risk of heart attack, stroke, and blood clots in transgender women.

However, there is no evidence to suggest an increased risk of cardiovascular problems in transgender men taking GAHT.

Researchers require further evidence from quality studies to increase their understanding of the potential risks of GAHT.

According to a 2023 study, the most common side effects of GAHT included:

That said, researchers require further studies over a longer period to fully understand the long-term effects of GAHT.

Learn more about how to start HRT as part of gender-affirming therapy.

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Experts recommend the suitability of HRT depends on the individual and any specific risk factors they may have.

Talking with a doctor can help people decide if HRT is right for them. Risk factors for HRT can depend on:

  • a person’s age
  • how long they are starting HRT after menopause
  • health conditions, such as breast cancer or cardiovascular disease
  • the type of HRT, dosage, and duration of treatment

People can also discuss other treatment options for menopause symptoms.

If people are considering GAHT, they can discuss treatment options and the potential risks and benefits with a doctor.

Once people have all the information about hormone therapy, they can decide whether the benefits outweigh the risks and whether it is the optimal treatment for them.

Below are answers to common questions about HRT.

What is the long-term damage of HRT?

HRT may increase the risk of some cancers. Estrogen-only HRT may increase the risk of endometrial cancer, while combined HRT may increase the risk of breast cancer.

HRT may increase the risk of cardiovascular disease in people who have existing cardiovascular disease, have taken HRT more than 10 years after the onset of menopause, or are older than 60 years.

What are the signs that you need hormone replacement therapy?

People may consider HRT if they are starting menopause, which can cause the following signs and symptoms:

What are the downsides of HRT?

HRT may cause temporary side effects, such as headaches or mood changes. The treatment may have more serious health risks for certain people. These risks may depend on:

  • age
  • when people start taking HRT
  • the type of hormones they are taking
  • the duration of treatment
  • any existing or previous health conditions

People can discuss any risk factors and side effects of HRT with a doctor to assess their individual risk.

People may take hormone replacement therapy (HRT) to manage menopause symptoms or as gender-affirming therapy.

The risks of HRT can depend on each individual. Factors such as age, duration of treatment, type of hormone therapy, and when people begin treatment can all affect risk.

People can discuss potential risks and benefits of HRT with a doctor to understand their individual risks.