Hormone replacement therapy (HRT) is emerging as a double-edged sword. While it is meant to provide relief for the hundreds of women undergoing painful menopausal symptoms, research has also found pertinent risks associated with the treatment. It is therefore important to know how best to use it to manage symptoms – and when to steer clear.
A study published by the National Center for Biotechnology Information states that the natural decline in estradiol (a key female sex hormone) during menopause leads to several adverse metabolic and health effects. “Approximately 40% to 60% of women seek treatment, while 20% may delay treatment for over a year,” the study adds.
Dr David Chandy, director of endocrinology and diabetology at Sir HN Reliance Foundation Hospital, Mumbai, explains, “HRT is prescribed selectively rather than routinely. Doctors recommend it only when symptoms are significant or when hormone deficiency affects long-term health.” While, initially, information and research into HRT were limited and unclear, deeper research, improved safety guidelines, and a more personalised approach to medicine have made the treatment more accessible and “helped rebuild confidence among both doctors and patients”.
Who needs it
HRT is most commonly used for women suffering from severe menopausal symptoms. Due to a drastic imbalance in hormonal levels during menopause, HRT serves to replace the hormones that are lacking.
“HRT may be considered when symptoms significantly affect daily life. These include hot flashes, night sweats, sleep disturbances, mood changes, vaginal dryness, and reduced quality of life. Other valid reasons include early or surgical menopause,” explains Dr Chandy.
Most women who require menopausal HRT are between 45 and 60 years of age. “However, younger women with premature menopause or ovarian failure may require HRT until the average age of natural menopause,” he adds. “HRT is advised to replace hormones that the body is no longer producing adequately. In women, it is most commonly used during menopause to relieve symptoms caused by low estrogen levels.”
“Besides menopause, HRT may be needed after the surgical removal of hormone-producing glands, in genetic conditions, or in chronic endocrine diseases,” Dr Chandy notes.
According to Dr Sanchita Biswas, head of department, gynaecology, Kailash Hospital, Greater Noida, HRT is being prescribed more frequently today, “though it is done selectively and only when medically necessary. Over time, acceptance of HRT has gradually increased due to improvements in medical knowledge and safety standards.”
“It is important to note that a patient needs to undergo an intensive check-up to confirm there is nothing that may contraindicate the benefits of the treatment,” warns Dr Biswas. Describing the diagnostic process before prescribing HRT, she says, “The treatment begins with a comprehensive medical history, symptom analysis, and physical examination. Blood tests and scans may also be suggested to assess hormone levels, bone health, and other risk factors.”
“After determining suitability for treatment, an appropriate personalised HRT regimen is devised based on the type, dosage, and method of administration,” she adds. A series of follow-ups is necessary to assess symptom improvement and monitor health, and the duration of treatment may vary depending on individual needs.
Adding to this, Dr Anita Soni, director of obstetrics & gynaecology at Dr LH Hiranandani Hospital, Powai, Mumbai, says, “Before starting HRT, doctors perform tests such as mammography, ultrasound, liver function tests, and PAP smears to rule out underlying conditions. Treatment is then prescribed in the form of tablets, gels, or patches, depending on patient needs.”
“HRT has been available in India for many years, but prescriptions have grown recently due to increased awareness about menopause and reduced social stigma. More doctors now discuss it as a safe and effective option for managing symptoms,” she adds.
Safe when monitored
Dr Soni notes that modern HRT is generally safe when monitored by a doctor. “Side effects are minimal, and risks are low if therapy is tailored to the patient’s health profile.” However, she also points out that research suggests HRT may contribute to an increased risk of breast and uterine cancer in some women.
Dr Chandy elaborates, “Most side effects are mild and temporary, such as breast tenderness, bloating, nausea, or irregular bleeding in the initial stages.”
“Certain risks, including blood clots or breast cancer, apply only to specific groups and are minimised through careful patient selection and regular monitoring. When prescribed appropriately, HRT is considered safe for most eligible patients,” he adds.
According to an article on HRT published by the Mayo Clinic, starting HRT at a later stage – around age 60, or 10 years after menopause – increases the likelihood of risks. Additionally, a review published by PubMed Central warns of its long-term effects. “The overall increased risk of serious adverse effects – including breast cancer, stroke, and pulmonary embolism – with long-term hormone replacement therapy (HRT) outweighs the potential benefits in disease prevention,” it states.
Dr Biswas, however, clarifies that more recent research and trials indicate that risks are relatively low with HRT, especially when started at the right age and used for an appropriate duration with the correct type of hormone.
“Although the risk of more serious side effects like blood clots or breast cancer is low, it depends largely on the woman’s age, the duration of treatment, the type of hormone used, and her overall health,” she says. “With proper screening, dosage, and monitoring, HRT can be safe.”
Cost and accessibility
The cost of HRT varies depending on the type, formulation, dosage, and delivery method, says Dr Biswas. “On average, patients may spend a few thousand rupees per month, including follow-up consultations. Advanced formulations can be more expensive.”
Dr Chandy offers a more specific estimate: “In India, HRT usually costs between `1,000 and `5,000 per month, depending on the type of hormones and follow-up tests. It is widely available in urban areas, hospitals, and specialist clinics.” However, the same cannot be said for rural areas, where healthcare penetration is lower and awareness about modern treatments remains limited.
“HRT is readily available in urban areas and medical stores, but in smaller cities, patients may need to make additional efforts to access it. Long-term HRT can also be slightly costly and difficult for some patients to afford,” says Dr Biswas.
Dr Soni adds that limited awareness about menstruation and menopause treatments further hinders accessibility. “Many women remain unaware of menopause management options, and social media misinformation often promotes quick fixes. This creates a significant gap between the need for HRT and its proper utilisation.”
Dr Chandy agrees, noting that the issue is often not availability but awareness. “Lack of awareness, fear of side effects, social stigma, and misconceptions – rather than lack of services – contribute to this gap. Better patient education and access to specialist care can help address the issue.”