HRT relieves symptoms of perimenopause and menopause but it also protects your future health
Globally, the proportion of menopausal women being prescribed hormone treatment is low - only around 5% in the US and 15% in England [1,2]. This is far lower than it was 25 years ago, leading to both suffering and poor health.
Many women avoid hormone replacement therapy (HRT) because they’ve been told it’s risky. Many clinicians avoid prescribing HRT as they are scared of perceived risks.
But the reality is that for most women, there is actually more risks in NOT using hormone therapy than in using it. When hormone levels (progesterone, estradiol, and testosterone) drop and stay low, the risk of long-term health problems rises -and the short-term effects can be life-changing. Hot flashes, night sweats, insomnia, brain fog, mood swings, and joint pain can disrupt sleep, work, relationships, and overall quality of life for years. There are health risks of not having HRT too.
RELATED: The risks of not taking HRT
Why hormones matter for your whole body
Many people think progesterone, estradiol and testosterone are only needed for reproduction or for periods, but these hormones do far more than regulate periods or fertility. They’re your body’s long-distance messengers - they are made in your ovaries, adrenal glands, brain and other tissues and they travel throughout your entire body to deliver instructions to your cells and organs, including your brain, bones, muscles, heart, liver, kidneys, and skin.
They act as chemical messengers that influence everything from your energy and mood to bone strength and brain function. These hormones have important roles that keep your body healthy and strong. When hormone levels fluctuate and reduce, your body struggles to function properly, and the effects impact every system, not just your reproductive organs.
The risks of not using hormone therapy
Menopause is not a brief transition; it’s a permanent change. Once your hormone levels are low, they are low for ever so this means that you will be menopausal for the rest of your life.
Most women today live into their 70s or 80s. That means you could spend 30 to 40 years menopausal, in a hormone-deficient state, if you don’t replace these missing hormones. Because progesterone, estradiol and testosterone affect your brain, bones, heart, muscles, metabolism, sleep, and sexual health, living for decades with low hormones can have serious effects on your health and quality of life.
Many women don’t realise that health problems in their 60s and 70s often began years earlier with the loss of hormones. For example, a hip fracture later in life isn’t just bad luck; bone strength starts declining when hormone levels reduce during menopause. The same is true for heart disease, cognitive changes, and even chronic fatigue. Without understanding this connection, women may treat symptoms without addressing one of the key drivers: hormone deficiency. Understanding this reality is essential for informed decision making.
RELATED: HRT in later life or after menopause
Musculoskeletal changes and bone loss
Muscle loss and weakness accelerate when hormone levels decline, which means that falls, frailty, and disability are more common. Your bones feel these changes too - bone loss speeds up, bone-building slows down, and the risk of osteoporosis and fractures increases if women are not replacing their missing hormones [3].
While many people think of fractures as a simple injury, a hip fracture due to osteoporosis is nothing like breaking a bone as a child or from a sports accident. At age nine, a broken arm might mean a cast and a quick recovery. In contrast, a hip fracture in your 60s or 70s often requires surgery, hardware like rods and pins, and usually months of rehabilitation. Recovery can bring pain, limited mobility, and a deep sense of isolation. Around 25% of women die within one year of a hip fracture due to osteoporosis, and around 70% lose their independence, with many never fully returning to their previous level of function [4].
RELATED: How can I keep my bones strong?
Genitourinary Syndrome of Menopause (GSM)
This condition isn’t just about discomfort during sex. GSM means the tissues of your vagina, vulva, and urinary tract become thin, dry, and less elastic when hormone levels stay low. The tissues of your urinary tract can also be affected. Over time, this can cause burning, pain, urinary urgency, and frequent urinary tract infections (UTIs). If GSM is left untreated, urinary tract infections can keep coming back and may spread to the kidneys. In severe cases, this can lead to urosepsis, a dangerous infection that can require hospitalization and can become life-threatening. Treating GSM with hormones – either vaginal hormones or systematic hormones (or both) helps keep these tissues healthy, lowers infection risk, and protects your overall urinary health, not just sexual comfort [5].
RELATED: Vaginal hormones: what you need to know
Hot flushes and sleep disruption
Many women are unaware that hot flushes and night sweats aren’t always short-term problems. Because they often interrupt sleep, women end up struggling with ongoing insomnia. Research has shown that frequent hot flushes can last an average of seven years. That’s a long time to feel exhausted and overheated night after night. This is one reason treatment with the right dose and type of hormones can make such a real difference as these symptoms don’t just disappear quickly for many women, and treatment with hormones can truly improve daily life [6].
RELATED: Hot flushes explained
Brain health and cognitive decline
When hormone levels drop, your brain often feels the impact. Hormones help protect nerve cells and support memory, mood, and clear thinking. Without them, you are more likely to notice brain fog, trouble concentrating, and memory lapses. Mood disorders such as anxiety and depression also become more common. Over time, low hormone levels increase the risk of cognitive decline and dementia, including Alzheimer’s disease. Women who take hormones have a lower future risk of developing dementia [7].
RELATED: Can HRT reduce your risk of dementia?
Cardiovascular disease risk
Heart health is deeply connected to your hormones. Before menopause, hormones work to keep blood vessels healthy and flexible. They also can support healthy cholesterol levels. When hormone levels drop, these protective effects decline. This raises the risk of high blood pressure, clogged arteries, heart attacks, and strokes. Cardiovascular disease is the number one killer of women, and the risk climbs quickly during menopause if hormones are not replaced. Treatment with hormones can help maintain heart health and reduce future risk of developing cardiovascular disease [8].
RELATED: Hormones and your heart health
Multiple medications and side effects
Many women are prescribed medications for their various symptoms and they would never need to take these if the root cause - hormone decline - was addressed. Without treatment with the right dose and type of hormones, women often take multiple drugs, including antidepressants, sleep aids, pain medications, blood pressure pills, statins, and diabetes medications. These only manage symptoms and often come with side effects, while the underlying hormonal imbalance remains untreated.
Hormones may not be the only factor behind chronic health problems, but declining hormone levels play a significant role. Addressing hormone deficiency doesn’t solve every health issue, but it tackles a key driver of many symptoms and long-term risks, and recent Newson Research data shows it can reduce reliance on other medications, including opioids [9].
RELATED: Can HRT and testosterone lead to a reduction in antidepressant and opioid prescribing?
The ripple effect of low hormones
Hormone loss doesn’t just affect physical health - it can negatively affect so many parts of your daily life. When sleep becomes disrupted, fatigue and brain fog naturally follow, making it harder to think clearly, stay patient, or feel emotionally steady. Work can become more challenging, too. Many women notice dips in productivity, more sick days, or difficulty keeping up, and research shows that unmanaged symptoms can even contribute to changes in work schedules or early retirement [10, 11].
Emotional wellbeing often declines during the menopause. Mood changes, anxiety, and a sense of overwhelm are common because changes in hormone levels can affect brain chemistry, sleep, and coping ability. Studies show that suicidal thoughts and depressive symptoms increase during this time [12].
RELATED: 'My intrusive thoughts eased with HRT'
In the absence of adequate treatment with hormones, some women turn to alcohol or other coping behaviors - and research suggests this is not rare. One study undertaken by Newson Research found that about one in three women report drinking more alcohol during menopause, and 15% consume more than the recommended intake [13]. The same research found that more women were turning to street drugs and gambling, often to try to improve their mental health symptoms which were occurring as a consequence of their changing hormone levels.
Relationships can feel the strain, too. Mood swings, irritability, changes in libido, and GSM-related discomfort can create distance or misunderstanding between partners. “Menodivorce” is becoming a recognised term, not because relationships are destined to fail at midlife, but because unaddressed symptoms place added stress on couples who might be already juggling busy lives [14].
RELATED: Emotionally supporting each other during menopause
Physical discomfort, including joint pain, weight changes, or plain exhaustion, often leads to being less active, which can reinforce the very symptoms women are trying to escape. None of this is about willpower or personal weakness. These ripple effects are well-documented in psychosocial and workplace research, and they highlight one simple truth: hormone health matters for every part of life.
It’s time to change the conversation
Menopause is permanent, and low hormones affect every part of your health and quality of life. The risks of avoiding hormone treatments – progesterone, estradiol and testosterone – are real and often overlooked. Today, we know that bioidentical hormones (hormones that match the ones your body naturally makes), used at the right dose, are safe for most women.
If you’re struggling with symptoms and/or are worried about long-term health, talk to a qualified clinician about hormone treatments. Far too many women are never offered hormone treatments for symptoms and health risks related to their declining hormones.
It’s time to change the conversation; from focusing on the perceived risks of using HRT to understanding the very real risks of not using it.
