After menopause, when your periods have stopped, your body doesn’t produce as much estrogen. For many women, the absence of estrogen brings on a host of unpleasant symptoms like hot flashes, vaginal dryness, and painful sex to name a few.

Menopause is a natural phase, and symptoms eventually subside for most women. But for some, symptoms are severe enough that they need hormonal intervention.

Hormone replacement therapy (HRT) is one of the most effective ways to relieve severe menopause symptoms. HRT may even offer protection against heart disease and bone loss from osteoporosis.

But that doesn’t mean HRT is completely risk-free. Whether it’s right for you depends on your age, when you entered menopause, and other risk factors.

Here’s a look at the risks and rewards to help you decide whether HRT is a good option for you.

Hormone replacement therapy involves taking a medication when your hormone levels drop. It contains:

  • estrogen (or estradiol, the most common form of the hormone in your body)
  • progesterone
  • or both of these hormones

HRT has a controversial history. Popularized in the 1960s as a way to stay youthful after menopause, HRT use peaked in the 1990s.

Then, in 2002, a study undertaken by the Women’s Health Initiative linked HRT to cancer and cardiovascular disease. After the WHI’s report was published, HRT use in the United States, the UK, and Canada dropped dramatically.

The WHI report has since been called into question. Newer studies have shown that HRT has lower risks and more benefits for women who start treatment before age 60 and within 10 years of menopause.

But many people are still hesitant to use HRT because of concerns about the risks it could pose.

Although there’s still confusion about HRT, many researchers say the benefits outweigh the risks. Let’s look at some of the best-researched benefits of HRT.

Alleviates menopause symptoms

The experience of menopause is different for everyone. Some people have symptoms that are so mild no medical treatment is needed.

For others, the symptoms can be so severe that it interferes with their ability to go about their daily life. In this situation, it’s usually a good idea to talk with a doctor about hormone replacement.

HRT may help ease menopause symptoms in the following ways:

  • Low-dose estrogen can relieve vasomotor symptoms such as hot flashes and night sweats.
  • Low-dose estrogen (in many forms) relieves genital and urinary symptoms of menopause, including vaginal dryness, painful sex, and urinary problems.
  • Prasterone and Ospemifene, two other hormone-based treatments, can also relieve genital and urinary symptoms.

Offers protection against cardiovascular disease

Numerous studies have confirmed that when HRT is started early, within 10 years of menopause, it can help protect your heart and vascular system from disease.

Before starting HRT, it’s important to undergo a physical exam to be sure you don’t already have signs of cardiovascular disease. Your doctor will likely want you to have a check-up every year while you’re on HRT to be sure you’re maintaining good heart health.

Helps ease depression

During the transition into menopause, which can last several years, many women experience some depression.

Estrogen delivered through a skin patch has been proven effective in easing symptoms of depression. There isn’t any evidence so far that estrogen can relieve depression after menopause.

Helps protect your bones

Menopause increases the risk of bone loss, osteoporosis, and fractures.

Research shows that 1 to 2 years of estrogen-based HRT in the form of a skin patch may help improve bone density and protect the structure of your bones as you get older.

Prevents loss of muscle mass

As you age, you tend to lose muscle mass. You need muscle mass for mobility, strength, and balance.

HRT can help prevent the loss of muscle. When combined with exercise, HRT may help increase muscle mass and strengthen your muscles.

May help prevent Alzheimer’s disease and Parkinson’s disease

According to a 2020 meta-analysis, estrogen-based HRT may have a protective effect against some neurological conditions.

In particular, it may play a role in decreasing the risk of Parkinson’s disease and Alzheimer’s disease.

Women under the age of 60, or who entered menopause in the last 10 years, stand to benefit most from hormone therapy.

For older women, or women who started menopause more than 10 years ago, the risks could outweigh the benefits.

When the Women’s Health Initiative published its report in 2002, doctors and patients began avoiding HRT out of concern that it could do more harm than good.

Although newer research has allayed some of those fears, there are still some risks to consider when deciding if HRT is right for you.

A higher risk of certain cancers

A 2020 study found that past use of HRT was linked to a higher risk of breast cancer. This elevated risk was associated with both estrogen-only and combined therapies.

There is some debate about the risk of ovarian cancer. Some studies suggest that both estrogen-only and combined therapies raise your risk of ovarian cancer. Other researchers say ovarian cancer is only a risk with estrogen-only therapy, but not with combination therapies.

Estrogen-only HRT may also increase the risk of endometrial cancer (also known as uterine cancer). A 2016 review of 28 studies concluded that the following HRT regimens may all increase the risk of endometrial cancer:

  • estrogen-only, sequential combination therapy (where you alternate between progesterone and estrogen at different parts of your cycle)
  • tibolone (a synthetic steroid)
  • micronized progesterone

Because of the risk, these therapies are generally recommended for women who no longer have a uterus.

Can increase the risk of blood clots

Studies have shown that HRT (in pill and patch forms) may raise your risk of blood clots and stroke. This risk may be highest for people over 60 or who started menopause over a decade ago. The longer you take HRT, the greater the increase in your risk.

Because of this risk, health experts recommend the lowest possible HRT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.

Raises the risk of gallbladder disease

Since estrogen builds up the concentration of cholesterol in the gall bladder, using HRT increases the likelihood of gallstones.

The risk is highest for women who use HRT longer than 5 years.

The Food and Drug Administration (FDA) has approved several categories of HRT. They include:

  • estrogen-only products
  • progesterone-only products
  • products that combine estrogen and progesterone
  • products that combine estrogen with other medications

These hormone medications come in several different forms, such as:

  • pills – examples include:
    • Cenestin, Enjuvia, Estrace, Femtrace, Menest, Ortho-Est, Premarin (estrogen)
    • Prometrium, Provera (progesterone)
    • Activella, Femhrt, Prefest, Prempro (estrogen and progesterone)
    • Duavee (combination estrogen and hormone medicine)
  • patches – such as:
    • Alora, Climara, Estraderm, Minivelle, Vivelle (estrogen)
    • Climara Pro, Combipatch (estrogen and progesterone)
  • injections – such as:
    • Delestrogen, Premarin (estrogen)
  • skin cream/spray – such as:
    • Estrasorb, Evamist, Premarin (estrogen)
  • vaginal rings or creams – such as:
    • Estrace, Femring, Ogen, Premarin (estrogen)

Creams and rings supply hormones to a localized area, which help to limit the amount in your system.

According to the FDA, you may want to avoid taking HRT if you’ve had:

Talk with your doctor about whether estrogen is right for you, if you have:

If you don’t want to use HRT to treat the symptoms of menopause, you might have some success with a non-hormonal treatment.

Some options that may help reduce the severity and frequency of hot flashes include:

Talking about menopause symptoms can be uncomfortable, especially when the symptoms feel personal.

It may help to make a list of your concerns in advance, so you can refer to the list if you forget.

Tell your doctor about:

  • any health conditions such as cancer, heart problems, liver disease, or blood clots
  • whether or not you’ve ever smoked
  • medications you’re taking for other conditions
  • allergies
  • side effects you’ve had from other hormonal treatment

While menopause is a natural change, it does involve a drop in your estrogen levels. This can trigger various symptoms which, in some cases, can be severe.

Hormone replacement therapy (HRT) may help ease many symptoms of menopause, including hot flashes and vaginal dryness. It may also lower your risk of heart problems, protect your bones and muscles, and reduce depression.

HRT, however, is not without its risks, especially for women over 60 or who started menopause more than 10 years ago.

Talk with a healthcare professional about whether HRT is right for you and whether the benefits outweigh any potential risks.