For millions of women in the United States, menopause brings more than the end of monthly cycles. Hot flashes, night sweats, sleep problems, brain fog, mood swings, and bone loss can take a real toll on everyday life. Hormone Replacement Therapy (HRT), sometimes called menopausal hormone therapy in the US, is one of the most effective ways to relieve these symptoms. But with benefits also come risks — and knowing the difference can help you make the best choice for your health.

What exactly is HRT?

Hormone Replacement Therapy (HRT) is treatment used to relieve symptoms of menopause by replacing hormones that the body stops producing as you age — mainly oestrogen and progesterone. For some, it’s life-changing. For others, it sparks a lot of questions (and some valid concerns). Let’s break it down.

Why do people take HRT?

When oestrogen levels drop during perimenopause and menopause, the body goes through big changes. Hot flushes, night sweats, brain fog, low mood, vaginal dryness, and bone thinning are all linked to this shift.

HRT can help by:

• Easing menopause symptoms – from hot flushes to sleep issues
  
  
• Protecting bone health – lowering the risk of osteoporosis
  
  
• Improving mood and concentration – thanks to more balanced hormone levels
  
  
• Supporting heart health – in some women, starting HRT earlier may lower cardiovascular risk
  

For many, HRT is the difference between struggling through every day and actually feeling like themselves again.

What are the risks?

No treatment is risk-free, and HRT is no exception. The key is understanding those risks and weighing them against the benefits with your doctor.

Possible risks include:

• Blood clots and stroke: Certain types of HRT, especially tablets, can increase this risk
  
  
• Breast cancer: A small increased risk has been linked to combined oestrogen-progestogen therapy
  
  
• Other side effects: Headaches, breast tenderness, or bloating — though these often settle with time or dose adjustment

The good news? Different types of HRT (patches, gels, sprays, tablets, or intrauterine devices) carry different risk profiles. That’s why it’s not one-size-fits-all.

Who might not be suitable for HRT?

HRT isn’t recommended for everyone. People with a history of breast cancer, certain types of blood clots, liver disease, or uncontrolled high blood pressure may be advised against it. That doesn’t mean you’re left with no options — non-hormonal treatments and lifestyle changes can also help.

The stigma around HRT

For years, HRT was painted as dangerous after flawed early studies made headlines. Since then, research has advanced, showing that for many women under 60 or within 10 years of menopause, the benefits can outweigh the risks. Still, misinformation lingers — and it often leaves women suffering in silence.

When to talk to a doctor

If menopause symptoms are making life difficult — disturbing your sleep, affecting your relationships, or getting in the way of work — it’s worth having a conversation about HRT. Bring a list of symptoms, questions, and any health concerns you have, so you and your doctor can decide together.

The bottom line

HRT isn’t a case of “turning back the clock.” It’s about giving your body the support it needs during a major hormonal shift. For some, it’s transformative; for others, it’s not the right fit.