Hormone replacement therapy (HRT)
HRT is prescribed for osteoporosis to help strengthen your bones and reduce your risk of breaking a bone. It is available in many forms to treat osteoporosis, including tablets, skin patches and gels.
After the menopause, your levels of the female sex hormone, oestrogen, decrease. This causes bones to lose strength. HRT treats osteoporosis by increasing your levels of oestrogen and reducing bone loss.
HRT for osteoporosis usually combines oestrogen with progestogen, a synthetic version of the hormone progesterone, which also decreases after the menopause.
There are more than 50 HRT products available in the UK, but only some are licensed to treat osteoporosis.
HRT doesn't reduce the pain caused by broken bones. But don't worry - if you're experiencing pain after breaking a bone, there are medications and treatments for pain that can help you.
Who should take HRT?
HRT is most likely to be prescribed if you are under 50 and in early menopause or you have a condition affecting your hormone levels.
If you are between 50 and 60 with a high risk of breaking a bone you may also be prescribed HRT, particularly if you have menopausal symptoms that need treatment.
HRT doesn't suit everyone. It may not be the best treatment for you if:
- you've had a blood clot
- you’ve had a stroke
- you’ve had breast, womb or ovary cancer
- you have heart disease
- you have untreated high blood pressure
- you have liver disease
Types of HRT for osteoporosis
Sequential combined therapy
Oestrogen and progestogen are taken separately, with oestrogen taken continually, and progestogen for around 12 days per month. This causes a bleed similar to a menstrual period.
Continuous combined therapy
Oestrogen and progestogen are taken continually throughout the month so that no bleed occurs. This is only prescribed if you’re at least one year past the menopause, to reduce the risk of irregular bleeding.
Oestrogen is taken continuously. This is only prescribed if you've had a hysterectomy.
A synthetic steroid medicine that mimics the activity of oestrogen, progesterone and testosterone in the body. Tibolone is used in the same way as ordinary HRT medications.
If you're prescribed HRT
Talk to your doctor about your medication, its side-effects and any risks. You can read the information on this page and in your patient information leaflet, so you know what to expect.
Our specialist nurse Helpline is here for you, if you have any questions or concerns.
How long to take it
To ensure the benefits outweigh the risks, HRT usually prescribed for no more than five years. You should review your treatment annually with your doctor.
To get the full benefits, HRT should be taken regularly as instructed by your doctor or pharmacist.
If you miss a dose
Missing the odd dose is unlikely to affect your overall bone health, but you should try to avoid it.
If you continually forget or struggle to take your medication, speak to your doctor about alternative treatment options. There may be something that suits you better.
Ending your treatment
If you stop taking HRT, the beneficial effects on your bones begin to decrease.
If you still have an increased risk of breaking a bone, your doctor may recommend you switch to a non-hormonal osteoporosis treatment.
Possible side effects
It’s unlikely you’ll experience any side effects. But if you do, they shouldn't last for long.
Known side effects include:
- Breast enlargement and tenderness
- Breakthrough bleeding
- Leg cramps
- Stomach upset, feeling sick and bloating
As research progresses, the list of known side effects may change. You can find more information on each side effect and how to reduce the symptoms on the hormone replacement therapy factsheet.
You may have seen other symptoms and side effects in your patient information leaflet. These side effects are listed because they were reported by patients in research trials, but it’s unclear if they were directly caused by HRT. They were also reported by patients taking the placebo (dummy treatment).
If you experience side effects
It's perfectly natural to be concerned by side effects although, in most cases, they do pass.
The best thing to do is speak to your doctor or pharmacist. They can assess if there's a better treatment for you. They can also help you work out whether HRT is causing the symptoms, or if something else is the cause, such as another medication.
There are some more serious health conditions associated with HRT.
The older you are when taking HRT, the higher your risk of the following conditions. This is because your risk naturally increases as you get older.
If you are prescribed HRT, your doctor has decided the benefit of taking the treatment outweighs any risks.
It's perfectly natural to feel concerned and unsure. Our specialist nurses are here for you, if you need to talk through your concerns and find out more about your risk.
You can find more detail on the following health risks on our hormone replacement therapy factsheet.
Breast cancer @(accordionItem.HeadingSize)>
Combined therapy (HRT with both progestogen and oestrogen) increases your risk of developing breast cancer.
There are around five extra cases of breast cancer in every 1,000 women using combined HRT.
If you stop taking your HRT treatment, your risk returns to normal within five years.
If you're taking oestrogen-only HRT, your risk of breast cancer is not affected.
Womb cancer @(accordionItem.HeadingSize)>
Oestrogen-only HRT significantly increases your risk of womb cancer.
There are between five and 55 extra cases per 1,000 women taking oestrogen-only HRT. The number varies depending on the dose of oestrogen and how long it’s used for.
To reduce the risk of womb cancer, progestogen is prescribed alongside oestrogen (known as combined therapy). If you are prescribed combined therapy, your risk returns to normal.
If you have had a hysterectomy, your doctor prescribes an oestrogen-only treatment.
Ovarian cancer @(accordionItem.HeadingSize)>
One study shows that HRT causes a slight increase in your risk of ovarian cancer.
There is an estimated one extra case per 1,000 women taking HRT for five years.
If you stop taking HRT, your risk gradually returns to normal.
Heart disease @(accordionItem.HeadingSize)>
Combined HRT is associated with a very small increase in the risk of heart disease.
This risk is smaller still if you start your treatment before the age of 60.
If you're taking oestrogen-only HRT, your risk of heart disease is not affected.
Blood clots @(accordionItem.HeadingSize)>
Your risk of a blood clot is increased by oestrogen-only or combined HRT tablets. It is not increased by HRT given as a skin patch.
It’s estimated that less than two out of 1,000 women who take HRT tablets for seven and a half years develop a blood clot.
Your risk of stroke is increased by oestrogen-only or combined HRT tablets. It is not increased by HRT given as a skin patch.
It’s estimated that an extra three to six women out of 1,000, who take HRT tablets for seven and a half years, have a stroke.
Your risk isn't affected if you're prescribed a different form of HRT.
Although there is no conclusive evidence, some studies suggest your risk of dementia is increased if you are taking HRT and over the age of 65.
This factsheet is currently under review following the results of a new research study.