If you’re going through menopause, hormone replacement therapy (HRT) might be on your mind. This involves taking doses of female sex hormones: estrogen, progesterone, or both. HRT is used to ease the unpleasant symptoms that are typically associated with menopause.
This phase is a normal part of aging. It typically happens between the ages of 45 and 54, and it’s marked by a drastic drop in estrogen and progesterone. As a result, you might have hot flashes, vaginal discomfort, and mood swings. Your risk for osteoporosis also shoots up.
HRT can reduce these symptoms. However, with that relief comes lots of side effects. Depending on your pre-existing conditions, HRT may or may not be right for you. Before you take the dive, learn about the risks and side effects of hormone replacement therapy.
1. Digestive Issues
From diarrhea to indigestion, digestive problems are common side effects of HRT. You may also get stomach cramps, bloating, gas, and nausea. Luckily, these symptoms typically go away within the first few months.1 You can also try natural remedies like drinking ginger tea and sniffing peppermint oil.
2. Breast Tenderness
Hormone replacement therapy side effects often impact the breast. Tenderness, swelling, and enlargement may develop. For some, this also points to increased breast density and therefore, a greater breast cancer risk.2
If your breasts are tender, a low-fat, high-carb diet might help.
3. Leg Cramps
Many women taking HRT also complain of leg cramps and swelling. It might also feel uncomfortable to move. Luckily, like the last two side effects, leg cramps eventually disappear. Regular exercise and stretching can make it feel better.3
4. Gallbladder Disease
With HRT pills, cholecystitis is a possible side effect. This is an infection marked by gallstones getting stuck in the gallbladder, causing painful inflammation. The only treatment? Surgery to remove the gallbladder. There’s a lower risk with HRT patches, though.4
5. Heart Problems
Hormone replacement therapy increases your risk for stroke by 41 percent and heart attack by 29 percent.5 These risks increase in women over 60 using combined HRT, and stroke is more likely with estrogen-only tablets. However, keep in mind that this side effect isn’t seen with estrogen HRT patches.6
If you smoke, HRT only adds to the existing risk of heart attack, stroke, and blood clots.7 Smoking also weakens the benefits of HRT, like osteoporosis protection and stopping hot flashes. Unfortunately, increasing the dose in response to this can be toxic.8
6. Endometrial Cancer
Another possible side effect includes endometrial cancer. The risk goes up if only estrogen hormone replacement therapy is used.9 Interestingly, adding progesterone actually combats the harmful effects of estrogen on the endometrium. It can be particularly useful for obese women, who are already at risk for endometrial cancer.10
7. Breast Cancer
The relationship between HRT and breast cancer risk depends on duration and what kind is used. A woman over 50 has little to no risk for breast cancer if she uses combined HRT for less than 5 years. The risk does increase if she uses it for longer.
But if only estrogen is used? Up to 15 years, there isn’t an increased risk.11
8. Unusual Bleeding
Rarely, HRT can cause strange vaginal bleeding.12 The good news is that starting with the lowest dose possible can reduce the risk of blood-related problems. HRT should be continued at this dose, and only increased when that dose stops working.13
9. Venous Thrombosis
HRT may increase the risk of blood clots by 47 percent.14 This usually happens inside the veins and causes a condition called venous thromboses. Women younger than 50, along with those ages 50 to 60 years old, have the greatest risk – especially within the first two years of HRT. If you’re already at risk for blood clots from different conditions, HRT may not be the best idea.
The risk of blood clots is higher with oral HRT, but there’s a lower chance with patches and gel.
Does HRT Cause Weight Gain?
Contrary to popular belief, HRT does not cause weight gain. Changes in weight are typically from menopause and other lifestyle factors. Any noticeable weight gain is usually just bloating and swelling.15
For some women, the benefits may outweigh these side effects. Talk to your doctor to see what’s right for you. As always, don’t be afraid to express any concerns or hesitations.
|↑1, ↑6||Hormone replacement therapy (HRT) and menopause. Better Health Channel.|
|↑2||Crandall, Carolyn J., Aaron K. Aragaki, Jane A. Cauley, Anne McTiernan, JoAnn E. Manson, Garnet L. Anderson, Jean Wactawski-Wende, and Rowan T. Chlebowski. “Breast tenderness after initiation of conjugated equine estrogens and mammographic density change.” Breast cancer research and treatment 131, no. 3 (2012): 969-979.|
|↑3, ↑4, ↑11, ↑13||Mattsson, L-Å., S. O. Skouby, J. Heikkinen, R. Vaheri, J. Mäenpää, and U. Timonen. “A low-dose start in hormone replacement therapy provides a beneficial bleeding profile and few side-effects: randomized comparison with a conventional-dose regimen.” Climacteric 7, no. 1 (2004): 59-69.|
|↑5, ↑14||Facts About Menopausal Hormone Therapy. National Institutes Of Health.|
|↑7||Estrogen and Progestin (Hormone Replacement Therapy). MedlinePlus.|
|↑8||Mueck, Alfred O., and Harald Seeger. “Smoking, estradiol metabolism and hormone replacement therapy.” Current Medicinal Chemistry-Cardiovascular & Hematological Agents 3, no. 1 (2005): 45-54.|
|↑9||Welnicka-Jaskiewicz, Marzena, and Jacek Jassem. “The risks and benefits of hormonal replacement therapy in healthy women and in breast cancer survivors.” Cancer treatment reviews 29, no. 5 (2003): 355-361.|
|↑10||Bjarnason, Nina H. “Endometrial cancer and hormone-replacement therapy.” The Lancet 366, no. 9481 (2005): 200-201.|
|↑12, ↑15||Hormone replacement therapy (HRT) and menopause. NHS Choices.|