Menopause is a biological process that many people will experience at some point in their lives. During this time, your body goes through numerous changes as it adjusts to fluctuating hormone levels.

The hormones that once existed in such vast amounts begin to dwindle as you pass childbearing years, and they’ll continue to decrease throughout the rest of your life. These changes can cause symptoms like hot flashes, mood swings, and even depression.

Hormone replacement therapy (HRT) can make a big difference in counteracting these symptoms by replacing the diminished hormones in a natural way.

But HRT isn’t without risks. Some forms of HRT have been linked to an increased risk of breast cancer, heart disease, and stroke.

Women taking estrogen and progesterone did have an increased risk of breast cancer, according to the American Cancer Society, but it was small. Women who took just estrogen didn’t have a high risk of breast cancer, but they did show an increased risk of uterine cancer.

You should carefully consider these risks before deciding if HRT is the best treatment option for your symptoms.

In the early years of HRT, doctors most often prescribed it in the form of synthetic prescription medications. These drugs are made from a blend of hormones isolated from a pregnant horse’s urine.

Premarin is the synthetic form of estrogen, while Provera is the synthetic version of progesterone. Though synthetic drugs used to be the preferred HRT they’ve become less popular in recent years.

Some risks were identified in clinical trials that led many people to seek out an alternative form of HRT called “bioidentical HRT.”

Bioidentical hormones are generally extracted from elements found in nature. Some examples of commercially available bioidentical HRT include Estrace and Vagifem.

Patients may need a custom compound of HRT when their prescribed strength isn’t commercially available or another dose form is needed. In compounded bioidentical HRT, a pharmacist mixes a special blend of hormones intended to replace the depleted hormones in your body.

The goal of HRT is to manage the symptoms of menopause, not necessarily to return the hormone levels back to a “normal” range.

Since each dose varies from person to person, compounded bioidentical hormones are difficult to test for safety and effectiveness on an overall basis.

The lack of information on the risks of bioidentical hormones causes many people to assume that these “natural” hormones are better or safer than synthetic hormones.

But the word “natural” is open to interpretation. Bioidentical hormones aren’t found in this form in nature. Rather, they’re made, or synthesized, from a plant chemical extracted from yams and soy.

The FDA has approved some bioidentical hormone supplements, including Bijuva, a bioidentical estradiol and progesterone capsule, but they do not regulate compounded HRT.

Though there’s no definitive answer, most experts believe bioidentical HRT involves the same risks as synthetic HRT. Neither type of HRT is considered to be safer than the other.

In your childbearing years, your ovaries produce estrogen and progesterone. These hormones regulate your reproductive cycle and promote the body’s use of calcium. The ovaries decrease their production of these hormones as you age, which often results in:

  • bone loss
  • a diminished sex drive
  • low energy
  • mood swings
  • hot flashes

HRT replenishes estrogen and progesterone levels in the body, helping to reduce these effects. This type of treatment comes with other benefits as well.

In addition to easing the symptoms of menopause, HRT may also reduce your risk for diabetes, tooth loss, and cataracts. Many people who go through successful HRT treatments are able to live a more productive and comfortable life.

HRT can help with bone loss. The International Osteoporosis Foundation recommends HRT as second line therapy for prevention of osteoporosis.

While some health benefits are linked to HRT, several risks are associated with it as well.

HRT has been connected to an increased risk for certain types of cancers, especially breast cancer. The studies that discovered a link between HRT and breast cancer refer to people being treated with EPT, but not estrogen alone.

But there are no studies that show that bioidentical HRT is any safer than synthetic HRT. The risk of breast cancer increases the longer someone engages in EPT, and the risk decreases once EPT is stopped.

On the other hand, a higher risk for uterine cancer also exists when menopausal people with a uterus use estrogen (ET) only.

Other risks for people undergoing HRT include stroke.

Though there are risks involved with HRT, it’s still the best way to treat severe menopause symptoms and improve quality of life.

You and your doctor can discuss the risks and benefits for you specifically and evaluate other treatment options. It’s critical to work closely with your doctor so you can decide what’s right for you.


How long does hormone replacement therapy last?

Anonymous patient


There is currently no set limit to how long HRT can be taken, but annual breast exams are highly recommended while taking HRT. In addition, blood pressure should be monitored periodically and any symptoms of blood clots, chest pain, or stroke should be addressed immediately. You and your doctor will need to work together to determine how long to continue your HRT.

Alan Carter, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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