If you’ve ever felt confused about hormone replacement therapy (HRT) for menopause, you’re not alone. Many people have strong opinions on it, and it can be challenging to tell what’s real and what’s a myth.

Hormone therapy is safe for many people going through menopause, but it’s not for everyone. In this article, we’ll separate common HRT myths from the latest research.

Myth 1

HRT Is Dangerous for Everyone

Many women hold off on asking their doctors about hormone therapy because they assume it isn’t safe. Like any prescription medication, hormone therapy comes with risks. However, it’s safe and effective for many people.

What actually determines your risk:

• Your age and timing — Hormone therapy may be a safe option for women up to age 59 who have begun the transition to menopause in the last 10 years.
• Your overall health — Risks are individual, which is why your doctor will discuss the possible benefits and risks with you and help determine whether the benefits outweigh the risks.
• The type of HRT — People taking hormone therapy for hot flashes require medication that travels through the entire body. Women who take hormone therapy for vaginal dryness may only need topical medication, which can lower the risks.
• Your dose and duration — Because hormone therapy comes with risks, current research recommends using it at the lowest dose possible for the shortest duration needed.

🗳️ Have you talked with a doctor about the risks and benefits of hormone therapy?

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Myth 2

HRT Carries a High Risk for Breast Cancer

Taking combined hormone therapy (both estrogen and progesterone) may slightly increase your breast cancer risk — but other factors matter.

• Timing — Most studies show that the risk doesn’t increase until after five years of treatment.
• Type — Research shows estrogen-only therapy may actually lower breast cancer risk after seven years of treatment.
• Delivery method — Taking systemic estrogen by mouth may have more protective effects than an estrogen skin patch.

A 2021 review found the risk of breast cancer when taking combination hormone therapy is less than 1 in 1,000. The authors noted that the increased risk from hormone therapy is less than the risks associated with drinking two glasses of wine per day and similar to those with obesity.

In other words, the risk is there, but it’s small. Several factors affect your risk of breast cancer. If you have a history of breast cancer or it runs in your family, talk with your doctor or schedule a telehealth appointment to learn if any types of hormone therapy are safe for you.

Myth 3

Natural or Compounded Hormones Are Safer Than Standard HRT

You may have heard about “natural” or compounded hormone therapy. Manufacturers often claim these products are safer than prescription hormones, but the evidence doesn’t back that up yet.

• Bioidentical hormones have the same chemical structure as the hormones your body makes, and companies market them as safer than traditional hormone therapy. The U.S. Food and Drug Administration (FDA) has approved certain bioidentical hormones for menopause symptoms, but that doesn’t make these safer.
• Many natural or bioidentical options are compounded — altered by a licensed pharmacist — and don’t need FDA approval. Companies that make compounded versions do not have to prove they’re safe or effective.
• Herbal remedies aren’t regulated either. Supplements marketed for menopause include soy, red clover, and black cohosh, but there isn’t enough scientific evidence to know whether they work or are safe.

If you hear that one of the above options is safer than prescription HRT, that is a myth.

Myth 4

HRT Is Bad for Your Heart

For some people, hormone therapy may raise the risk of blood clots and stroke — but the picture is more nuanced than a simple yes or no.

• Timing matters most — People who start hormone therapy closer to their last period, such as those in their 50s, are at less risk than those who start in their 60s. A 2021 review found that starting before age 60 or within 10 years of your last period likely has neutral to beneficial effects on heart disease.
• For early menopause, HRT can protect your heart — Because estrogen supports healthy blood vessels and blood lipid levels, losing it early raises heart disease risk — and hormone therapy lowers that risk for people whose estrogen drops before age 40.
• Stroke risk rises slightly with combination and estrogen-only therapy — The risk of stroke increases slightly with both types, and starting age doesn’t seem to change that risk.
• Blood clot risk depends on what you take — Oral pills raise blood clot risk more than a skin patch, natural progesterone is likely safer than synthetic versions, and lower doses are less likely to cause clots.
• Type matters too — Combination therapy may slightly increase your risk while estrogen-only treatment doesn’t, and patches may carry less added risk than pills.

Myth 5

HRT Is Only for Hot Flashes (or Only for Severe Symptoms)

Hormone therapy has been approved by the FDA to treat several menopause symptoms, including hot flashes. Other symptoms include:

• Vaginal dryness — Taking estrogen can improve vaginal dryness, itching, and irritation.
• Pain with intercourse — Vaginal dryness can make sex painful. Hormone therapy can improve pain and burning with intercourse, but it has not been proven to increase sex drive.
• Urinary problems — Taking vaginal estrogen may help address urinary changes, such as an increase in the frequency or a strong urge to urinate. It may also prevent urine leaking and urinary tract infections.
• Bone loss — Hormone therapy may improve bone density and lower the risk of fractures.

Although not FDA-approved to treat insomnia and mood changes, hormone therapy may help improve your mood and sleep quality, especially if your sleep is interrupted by night sweats.