HRT for Menopause: Benefits, Risks, and Who Should Avoid It

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Menopause hormone therapy, often called HRT, replaces some of the hormones that fall during menopause. It is the most effective treatment for hot flashes and night sweats, and it can also help with sleep, mood, vaginal dryness, and bone health. It is not risk-free, and it is not right for everyone.

This article explains the main types, the benefits, the risks, who should be careful, and how long it is usually taken. For the symptoms themselves, see Common Menopause Symptoms and Hot Flashes: Causes and What Helps.

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Quick Answer

The NHS says that for most women the benefits of HRT usually outweigh the risks, and that the risk of serious side effects is very low (1). The Menopause Society reaches a similar view for healthy women who are under 60 or within 10 years of their last period (2). The balance is less clear for women who start later or who have certain health conditions, so decide with your doctor.

What Hormone Therapy Is

Around menopause, the body makes less estrogen and progesterone. Hormone therapy replaces these hormones. It usually contains estrogen and a second hormone called progestogen, or estrogen alone for women who have had a hysterectomy (3).

Estrogen-Only Therapy

Estrogen alone is for women who no longer have a uterus, for example after a hysterectomy. Women who still have a uterus need a second hormone with it, which is explained next. Vaginal estrogen is the one exception, and it is covered under ways to take it.

Combined Therapy

If you still have your uterus, you need progestogen with estrogen. The NHS says that taking both helps protect against cancer of the uterus (4). The progestogen can come as tablets, a patch that contains both hormones, or a hormone coil. If you still have periods, you usually take progestogen for only part of each cycle. If you have not had a period for a year, you usually take both every day.

Ways to Take It

Hormone therapy comes as tablets, skin patches, gels, and sprays. Vaginal estrogen comes as a cream, tablet, pessary, or ring and is used for vaginal symptoms only. It can be used without progestogen even when you still have a uterus. The way you take estrogen matters for some risks, which are covered below.

Benefits

Hormone therapy relieves hot flashes, night sweats, sleep problems, anxiety, low mood, and vaginal dryness. The NHS says symptoms usually improve within days or weeks (1). The Menopause Society also states that it is the most effective treatment for hot flashes and for vaginal and urinary symptoms of menopause (2).

Hormone therapy also helps prevent bone thinning, which is called osteoporosis. This matters most for women whose periods stopped before age 45. If you want to compare it with other options for hot flashes, see the non-hormone treatments in Hot Flashes: Causes and What Helps.

Risks

The risks depend on the type of hormone therapy, the dose, how you take it, your age, and how long you use it. The main ones listed by the NHS (1) are:

Breast cancer. Combined HRT slightly raises the risk, about 5 extra cases per 1,000 women who take it for 5 years. The risk rises with longer use and falls after you stop. Estrogen-only HRT has little or no effect.
Blood clots. Tablets raise the risk, although it stays very low. Patches, gels, and sprays do not.
Stroke. Tablets raise the risk slightly, but patches, gels, and sprays do not. The risk is very low, especially under age 60.
Heart disease. HRT has little or no effect on the risk of coronary heart disease.
Dementia. It is not known whether HRT raises or lowers the risk. Any change is likely to be small.

The Menopause Society adds that lower doses and skin patches may lower the risk of blood clots and stroke (2). Its 2022 position statement also says the balance of benefits and risks looks less favorable for women who start after age 60 or more than 10 years after menopause (2).

What Changed in 2026

In February 2026, the U.S. Food and Drug Administration (FDA) approved new labels for six menopausal hormone therapy products. The new labels no longer have boxed warnings about heart disease, breast cancer, and probable dementia. The FDA said it made the change after reviewing the scientific research, and more products are expected to follow (5).

The FDA also pointed to studies showing that women who start hormone therapy within 10 years of menopause, usually before age 60, had lower death rates and fewer fractures (5). A new label does not mean that hormone therapy is right for every woman. Your age, health, and family history still decide whether it suits you.

Who Should Be Careful

The NHS says to tell your doctor before starting estrogen if any of these apply to you (6):

You have had breast cancer, are being tested for it, or are at high risk because of your family history.
You have had any other type of cancer.
You have vaginal bleeding with no known cause.
You have had a blood clot in a vein, or you have a condition that raises the risk of clots.
You have had angina or a heart attack.
You have liver problems.
You are pregnant or breastfeeding.
You have diabetes, high blood pressure, or migraines.

Some of these mean you should not take hormone therapy at all. Others mean your doctor may choose a different type or a different way to take it. For example, the NHS says women at risk of blood clots are usually advised to use patches, gel, or spray instead of tablets (1). Untreated high blood pressure needs to be brought under control first.

How Long Can You Take It?

The NHS says most women take HRT for 2 to 5 years, and sometimes longer (3). There is no fixed time limit. The Menopause Society says hormone therapy does not need to be stopped routinely at age 60 or 65, and it can be continued for persistent hot flashes, quality-of-life problems, or bone protection after a doctor has weighed the benefits and risks (2).

Treatment usually starts at a low dose. A doctor usually reviews you about 3 months after you start or change treatment, and then once a year (3). The breast cancer risk with combined HRT grows with the length of use (1), so the decision to continue is shared between you and your doctor and checked regularly (2).

Side effects are usually mild and often pass within 3 months. If they do not, ask your doctor about a different dose or type. Vaginal estrogen is a special case: the Menopause Society says it can be used at any age and for a long time if needed for vaginal and urinary symptoms (2).

Does It Work as Birth Control?

No. The NHS says you can still become pregnant while taking HRT (3). If you are under 50, use contraception until 2 years after your last period. If you are over 50, use it until 1 year after your last period (3). For the options, see Birth Control Options Explained.

When to See a Doctor

Consider speaking with a healthcare professional if:

You are over 45 and thinking about hormone therapy.
You are under 45 and have menopause symptoms, because this can be early menopause.
Hot flashes, poor sleep, or low mood affect your daily life.
You have a history of cancer, blood clots, or liver problems and want to know your options.
You take hormone therapy and notice leg pain or swelling, chest pain, sudden shortness of breath, or a severe headache.
You have unexpected vaginal bleeding while taking HRT.

Chest pain, sudden shortness of breath, or signs of a stroke need emergency care. Call your local emergency number. For other changes during this stage of life, see Early Signs of Perimenopause and Perimenopause Weight Gain: Why It Happens and What Helps.

Conclusion

Hormone therapy is the most effective treatment for hot flashes and night sweats, and it also helps with vaginal dryness and bone health. For many healthy women under 60, the benefits are larger than the risks. The risks are real, though, and they change with the type, the dose, the way you take it, and your health history.

There is no single right answer. Talk to a doctor about your symptoms, your own and your family’s health history, and what matters most to you. You can start, change, or stop hormone therapy later, and your doctor should review it with you regularly.

Menopause Hormone Therapy: Benefits and Risks

Quick Answer