Is hormone replacement therapy (HRT) safe?

Dr. Dawn Marcus

Hormone replacement therapy (HRT) has been routinely used to reduce unpleasant symptoms of early menopause, such as hot flashes, mood swings and vaginal dryness. A Women's Health Initiative study reported that using hormone therapy long-term resulted in more health risks than benefits for some women. This study found slightly increased risks for developing heart disease, breast cancer, stroke and blood clots in women treated with hormone therapy. The risk was higher in older women who had started menopause more than 10 years before starting HRT. Since that time, doctors have closely examined the results of that study and other studies in women to determine how hormone therapy can be used safely.

The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

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The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause (A DiaMedica Guide to Optimum Wellness)

Migraines are a common, controllable type of headache that affects one in every six women, more than 20 million in the United States alone. The Woman’s Migraine Toolkit helps readers take charge of...

There are many benefits to taking exogenous sex hormones such as estrogen, progesterone and sometimes testosterone as hormone replacement therapy (HRT) for menopause. HRT can improve mood, hot flashes, vaginal dryness or atrophy and even libido. For some women this can also help slow down bone loss leading to osteoporosis. Primary risks include thromboembolic events such as deep vein thrombosis (DVT) or stroke, especially in estrogen-containing products. Other risks include the development of estrogen-dependent cancers. It is important to review your personal risk factors prior to starting HRT.

Dr. Jill A. Grimes, MD
Family Practitioner

Current evidence-based medicine suggests that taking hormone replacement therapy (HRT) at the time of menopause may decrease your risk of developing dementia, but starting HRT late in life can increase your risk. Women should factor this in when talking with your physician regarding pros and cons of HRT.

Recent research suggests that in the first year of treatment, hormone replacement  therapy (HRT) may increase the risk of heart attacks for women who already have narrowing of the coronary arteries due to arteriosclerosis (hardening of the arteries). Studies are underway to help provide patients and physicians with definitive answers. For women with a history of heart disease, recent research suggests that long-term HRT use affords no protection against a second heart attack, and may even increase the risk slightly.

Women who have heart disease or have had a heart attack should not start HRT (even short term) without first discussing all the benefits and risks of this treatment method with her primary healthcare practitioner and possibly her cardiologist.

Dr. Marina Johnson

In 2002, the Women’s Health Initiative study reported increased risks or heart attacks, strokes, blood clots and breast cancer with the use of Prempro, a pill containing Premarin (horse estrogen) and Provera (synthetic progestin.) Since then it’s been determined that the heart disease was seen only in older women who started HRT more than 20 years after menopause. Women beginning HRT within 10 years of menopause did not have this increased risk. It’s also been determined that the increased risk of heart attacks, strokes and blood clots occurs from taking oral estrogen that causes the liver to produce harmful byproducts. A safer option is to use estradiol patches, gels or cream that do not adversely affect the liver.


Hormone replacement therapy (HRT) was once the most commonly prescribed treatment for menopause, but it is now known that it can increase the risk of heart attack, blood clots, stroke and breast cancer, regardless of the type of therapy used or its route of administration. Furthermore, contrary to popular belief, both bioidentical and nonbioidentical preparations carry these risks. Despite this, HRT is still the most effective way to alleviate menopausal symptoms, but it must be used with caution and with the understanding that the symptoms will return when the hormone replacement is stopped.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.