Hormone replacement therapy (HRT)
HRT is medication that mimics the female hormones oestrogen and progesterone. It can be prescribed to women going through menopause to relieve menopausal symptoms, to prevent bone loss and to treat osteoporosis.
When you reach the menopause, oestrogen levels decrease which causes many women develop symptoms such as hot flushes and sweats. The decrease in oestrogen levels also causes bone loss and the menopause is an important cause of osteoporosis.
HRT is available in many forms including tablets, skin patches and gels. It usually combines oestrogen with progestogen, a synthetic version of the hormone progesterone. On its own, oestrogen may be used by women who have had a hysterectomy.
Who should consider taking HRT for their bones?
It is important to consider taking HRT if you reach the menopause early, before the age of 45 and especially before the age of 40. An early menopause means you lose the protection that oestrogen gives your bones at an earlier age than normal. This increases your risk of osteoporosis and broken bones. If you have had an early menopause, talk to your healthcare professional about taking HRT until you are about 50. This is the average age for menopause.
If you need treatment to strengthen your bones in the early years after the menopause, HRT is also an option after the age of 50 until around 60. It is particularly helpful for women needing osteoporosis treatment who are also experiencing menopausal symptoms.
Like any osteoporosis medication, 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.
Is HRT safe to take for osteoporosis?
As with all medications, there are risks linked to taking HRT as well as benefits. The risks of taking HRT are not the same for everyone. They differ from one woman to another, depending on many factors such as your age, weight, medical and family history. It is important to consider your personal risks and the benefits to help you decide if HRT is the right treatment for you, which type to use and how long to use it for.
Many, but not all, types of HRT are linked with a small increase in breast cancer risk, which increases with the duration of treatment. Some types of tablet HRT can increase the chance of developing blood clots and heart disease, whereas oestrogen through the skin as a patch, gel or spray does not have these risks.
There have been many reports in the media about HRT and these have not always been accurate or balanced, causing worry and confusion about long term health risks.
HRT is a safe and effective treatment when it’s prescribed in the right way for the women who need it. It is important to discuss the risks and benefits with your healthcare professional, so you can make an informed choice.
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.
How long is it taken for?
HRT can be taken as long as the benefits outweigh any risks. This will depend on your individual circumstances which your doctor can advise you about. Your medication should be reviewed every year or so to make sure it’s still the right choice for you.
When 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 will recommend you switch to a different type of osteoporosis treatment.
What are the possible side effects?
It’s unlikely you’ll experience side effects and if you do, they generally don't last for long. Known side effects include:
- Breast enlargement and tenderness
- Breakthrough bleeding
- Leg cramps
- Stomach upset, feeling sick and bloating
If you experience side effects, it's perfectly natural to be concerned but in most cases they do pass quickly.
The best thing to do is speak to your healthcare professional. They can assess if there's a better treatment for you. They can also help you to work out whether the symptoms are caused by HRT or something else, such as another medication.
Call our Helpline if you have questions about whether HRT might be a good choice for you.
For information about any current shortages of HRT, please visit the British Menopause Society.
Our factsheet providing more detailed information is currently under review.