Does HRT cause cancer?
Hormone Replacement Therapy (HRT) is a widely discussed topic, particularly when it comes to its potential link to cancer. With so much conflicting information available, it’s essential to understand the facts. In this blog, we’ll explore what HRT is and how it works and examine the data surrounding its risks and benefits, helping you decide whether it’s right for you.
What Is HRT?
Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of menopause by replenishing hormones that naturally decline as a woman ages, particularly oestrogen and progesterone. These hormones are critical in regulating many bodily functions, including menstrual cycles, bone density, and mood.
Women often turn to HRT to manage symptoms such as hot flushes, night sweats, mood swings, vaginal dryness, and reduced libido. For some women, HRT provides significant relief and improves their quality of life during menopause.
How Does HRT Work?
HRT works by restoring the levels of hormones that decrease during menopause. The type and dosage of HRT can be tailored depending on whether you need oestrogen-only HRT or combined HRT (which includes both oestrogen and progesterone). In the conventional medicine setting this is usually approached as
Oestrogen-only HRT: In the conventional medicine setting This is generally prescribed to women who no longer have a womb/have had a hysterectomy
Combined HRT: This includes both oestrogen and a progestogen, and it’s typically prescribed to women who still have a womb and need endometrial protection
Who Needs HRT, How to Get It, and the Forms Available in the UK
HRT is typically prescribed to women experiencing moderate to severe menopause symptoms that interfere with their daily life. However, not all women require HRT, and the decision should be made in consultation with a healthcare professional, considering both the benefits and risks.
In the UK, HRT is available through the NHS and privately, but there are important differences in the types of HRT offered in these systems. Understanding these options is key to making an informed decision about what’s best for your health.
Types of HRT:
Synthetic HRT: The majority of HRT available through the NHS consists of synthetic hormones. These include chemically altered versions of oestrogen and progesterone that are effective at managing symptoms. However, synthetic hormones may not be as closely matched to the body’s natural hormones, which can lead to increased side effects in some women.
Body-Identical HRT: Body-identical hormones are a form of HRT that are structurally identical to the hormones naturally produced by your body. In the UK, some body-identical oestrogens and progesterones are available on the NHS, often in the form of gels, patches, or oral tablets. These are generally well tolerated and can offer a more natural option for women looking to minimise side effects.
Bioidentical HRT: Bioidentical HRT is available privately and refers to hormones that are custom-compounded by a private pharmacy to match the exact needs of an individual woman. These are similar to body-identical hormones but often include personalised formulations based on urine or blood tests. Bioidentical HRT may offer more flexibility in dosing and combinations, which can be particularly beneficial for women with specific hormonal imbalances or sensitivities.
Forms of HRT Available in the UK:
Tablets: A commonly prescribed form, taken orally, and available through the NHS.
Patches: Available through the NHS, these are applied to the skin and release hormones gradually into the bloodstream, often considered a more stable way to receive hormones.
Gels: Also available on the NHS, gels are applied to the skin daily and offer a flexible way to adjust dosage.
Implants: These are inserted under the skin and release hormones over time. Implants are usually a private option and may provide a more consistent hormone level for women who prefer not to take daily treatments.
Vaginal Creams, Rings, or Pessaries: Used for localised relief of vaginal symptoms such as dryness, itching, or discomfort, and are available on the NHS.
The Key Differences:
NHS vs. Private HRT: While the NHS provides effective HRT options, private prescribers like myself offer access to a wider range of body-identical and bioidentical hormone therapies. In private care, you may benefit from more personalised, compounded bioidentical hormone formulations that are tailored to your unique hormone profile, as determined through more detailed testing (such as saliva or blood tests). These private options offer greater flexibility in hormone dosage and combinations, which may be especially helpful for women with complex or resistant symptoms.
Customisation: Private prescriptions allow for a more individualised approach, meaning that your dosage and the form of HRT can be finely tuned over time, with greater attention paid to your specific hormonal needs. This flexibility isn’t always available through the NHS, where treatment options tend to follow more standardised protocols.
If you’re looking for a more tailored approach to HRT that aligns with your specific needs, private consultations with a specialist like myself can provide a deeper level of support and customisation.
A Brief Overview of the Famous Study and Its Links to Cancer
The conversation surrounding HRT and cancer began in earnest following a famous study, the Women’s Health Initiative (WHI) study in 2002. This large study initially suggested that HRT, particularly combined oestrogen and progesterone therapy, could increase the risk of breast cancer, heart disease, stroke, and blood clots.
This study led to widespread fear about the safety of HRT, with many women and healthcare providers opting to avoid it altogether. However, it’s important to understand the context of these findings and how newer data presents a clearer picture.
The True Data and the Benefits of Taking HRT
In the years since the WHI study, further research has helped clarify the risks and benefits of HRT. While some risks exist, especially for women over 60 or those with certain medical histories, the increased risk of breast cancer from HRT is much lower than initially suggested. It is also important to note that many lifestyle factors, such as obesity, alcohol consumption, and lack of physical activity, can pose higher risks of cancer than HRT use in many cases.
For many women, especially those under 60 and those who start HRT within 10 years of the onset of menopause, the benefits of HRT far outweigh the risks. These benefits include:
Relief from menopausal symptoms: HRT is the most effective treatment for reducing hot flushes, night sweats, and vaginal dryness.
Improved bone health: HRT helps maintain bone density and reduces the risk of osteoporosis, which becomes more prevalent after menopause.
Heart health: For younger women starting HRT, there may be some cardiovascular benefits, as it can help protect against heart disease.
Conclusion: The Individualisation of Dosage and Needs
One of the most important aspects of HRT is that it will provide the most benefit if it is individualised to each woman’s needs. There is no "one-size-fits-all" approach, and therefore, getting the right type and dose of HRT should be tailored to a woman’s medical history, symptoms, and personal preferences for the most success.
I work closely with my clients to ensure their HRT is carefully monitored and adjusted based on their unique circumstances. This personalised approach allows us to optimise the benefits of HRT while minimising risks, providing a balanced, holistic plan to support your health and well-being.
I’m an independent prescribing pharmacist and registered nutritional therapist specialising in fertility and women’s health. If you’d like to explore whether HRT is the right option for you, learn more about me and how my unique approach can support your health here. As an independent prescriber and registered nutritional therapist, I blend scientific expertise with a holistic, functional medicine perspective to provide personalised care to my clients. To begin your healing menopause journey, head to my online booking form and apply to work with me in person at my Harley Street and Gerrards Cross clinic locations or online today.