HRT in Plain Language: What the Evidence Actually Says

Few treatments in modern medicine have had a rougher public relations journey than hormone replacement therapy. Praised in the 1990s, abandoned after alarming headlines in 2002, and steadily rehabilitated since, HRT now sits in a strange place: the science has moved on, but public fear has not. This article walks through what the evidence actually says, in plain language, so you can have a real conversation with your doctor instead of a fearful one.

What HRT is, in one paragraph

HRT replaces the oestrogen your ovaries stop producing around menopause. If you still have a uterus, progesterone or a progestogen is added to protect the womb lining. It comes as tablets, skin patches, gels, and sprays, plus local vaginal oestrogen for dryness and urinary symptoms. Those delivery routes matter more than most people realise, because the risk profile of a patch is not the same as a tablet.

The 2002 scare, and what went wrong

The fear dates from a large American trial, the Women's Health Initiative, which was stopped early after reporting increased risks of breast cancer and heart disease. The headlines were dramatic. The details were not reported. The average participant was in her sixties, often more than a decade past menopause, and the trial used one specific oral formulation that is used far less today. Later analysis showed the absolute risks were small, and that results in women who started HRT near menopause looked considerably more favourable. Researchers involved in the trial have since said publicly that the findings were overgeneralised. Millions of women stopped or never started treatment based on a study population that did not resemble them.

What the current evidence supports

Today, major menopause societies broadly agree on several points:

• HRT is the most effective treatment available for hot flushes and night sweats
• It helps many women with sleep disturbance, mood symptoms linked to the transition, and joint aches
• It protects bone density and reduces fracture risk while it is taken
• For most healthy women who start within about ten years of menopause and before 60, the benefits are generally considered to outweigh the risks
• Local vaginal oestrogen treats dryness and recurrent urinary symptoms with minimal absorption into the body, and is considered suitable for most women, often long term

None of this makes HRT compulsory or universal. It makes it a legitimate option to weigh, rather than a hazard to avoid on principle.

The risks, stated honestly

Honesty matters in both directions. Combined HRT is associated with a small increase in breast cancer risk with longer use, an increase generally described as similar in scale to lifestyle factors such as regular alcohol intake or carrying excess weight. Oral oestrogen slightly raises the risk of blood clots, which is why doctors often prefer patches or gels, particularly for women with clot risk factors. Some women should avoid systemic HRT altogether, including most women with a history of breast cancer, and that decision belongs with a specialist.

The key idea is that risk is not one number. It depends on your age, how you take the hormones, what you take, your family history, and your other health conditions. A blanket 'HRT is dangerous' is as inaccurate as a blanket 'HRT is safe'.

Making the decision from Mauritius

HRT is available in Mauritius through both the public system and private practice, though not every doctor is equally current on menopause care, and formulations on the shelf vary between pharmacies. If your regular GP seems hesitant or dismissive, it is entirely reasonable to seek a second opinion from a gynaecologist or a doctor with a stated interest in menopause. Bring a symptom diary, your personal and family medical history, and your questions written down.

Useful questions include: given my history, do my likely benefits outweigh my risks? Would a patch or gel suit me better than tablets? What should we review after three months? What are my options if I cannot or prefer not to take hormones?

HRT is a personal decision, not a moral one. Some women feel dramatically better on it. Others manage well without it. The evidence exists to inform your choice, not to make it for you, and no article, including this one, replaces an individual assessment by a qualified professional.