New studies say hormone replacement therapy given timely at menopause helps in better cognition and lower Alzheimer’s risk. But does HRT not increase cancer risk? How does a woman choose? Dr Pakhee Aggarwal, senior consultant, gynae oncology, Indraprastha Apollo Hospital, Delhi, says: “HRT can have benefits, particularly in relieving symptoms such as hot flashes, night sweats and vaginal symptoms. However, it is not without risks.
Some forms of HRT, particularly combined estrogen and progesterone therapy, have been associated with a small increase in breast cancer risk with longer use. The risks can vary depending on the type of HRT, dose, duration and a woman’s individual health history. The decision should, therefore, be individualised. A woman should discuss her symptoms, age, time since menopause, family and personal medical history and other risk factors with her doctor. HRT should not be started only with the aim of preventing Alzheimer’s disease, as more evidence is needed on this benefit.”
Ideally, who should get HRT, or is it for everybody?
HRT is not needed by every woman going through menopause. It is generally considered for women who have troublesome menopausal symptoms and, in some cases, for protection against bone loss.
It is usually considered to have a more favourable benefit-risk balance in healthy women who are below 60 years of age or within 10 years of menopause, provided there are no reasons to avoid it. Women who experience menopause at a younger age may also be advised HRT in appropriate cases.
The decision should always be made after an individual assessment rather than routinely recommending it to everyone.
What are the possible side effects of HRT?
Some women may experience breast tenderness, bloating, headaches or irregular bleeding, particularly when starting treatment. These symptoms may improve with time or after adjusting the treatment.
There are also potential longer-term risks, including blood clots and, depending on the type of HRT, a possible increase in breast cancer risk. The risks are different for different women and different HRT preparations, which is why regular review with a doctor is important.
Can certain foods or lifestyle changes act as a replacement for HRT?
There is no food or lifestyle measure that can directly replace HRT. However, lifestyle plays an important role in managing health during and after menopause.
Regular exercise, adequate sleep, maintaining a healthy weight, a balanced diet, avoiding smoking and limiting alcohol can support bone, heart and brain health. Some women may also find that identifying and avoiding triggers such as excessive heat, spicy foods or alcohol helps with hot flashes. Dietary supplements or herbal products should not automatically be considered safer alternatives to HRT, as their effectiveness and safety can vary.