Is HRT safe for my bones? Benefits and risks
Is HRT good for your bones? Plain numbers on the hip fracture benefit, breast cancer and stroke risks, age, and patch versus tablet. Aggarwal Clinic, Patiala.
This page is for women around or after menopause who are thinking about HRT. HRT means hormone therapy for menopause. There is no single yes or no answer to whether it is safe. The balance of benefit and risk depends on your age, the type of HRT, how you take it and how long you take it. This page puts the benefits and the risks side by side, in the same numbers.
Most of the numbers below come from a large US trial called WHI. The women in it were 63 on average, and the trial used older tablet forms of HRT. Modern patches and progesterone have not had a similar trial for fractures or breast cancer.
Does HRT protect my bones?
Yes, while you take it. In WHI, women on combined HRT, which means oestrogen plus progestin, had about a third fewer hip fractures. That was 5 fewer hip fractures for every 10,000 women each year. The benefit fades after HRT stops.
What are the risks?
In the same trial, for every 10,000 women on combined HRT each year, there were:
- 8 more breast cancers
- 8 more strokes
- 8 more blood clots in the lung
- 7 more heart events
Women without a womb who took oestrogen alone had no rise in breast cancer. They had 12 more strokes per 10,000 women each year.
Does the breast cancer risk depend on how long I take it?
Yes. The risk rises the longer you use HRT. It is higher with combined HRT than with oestrogen alone. Less than 1 year of use adds little risk.
Does my age matter?
Yes. The balance of benefit and risk is better in women under 60, or within 10 years of their last period. It is worse after 60.
Should I take HRT only to protect my bones?
Guidelines disagree. A US prevention panel advises against HRT taken only to prevent disease. The Indian Menopause Society lists it as one option for women at higher fracture risk within 10 years of menopause.
Is a patch or gel different from a tablet?
HRT tablets raise the risk of blood clots. The UK bone guideline says HRT through the skin, as a patch or gel, at standard doses does not.
I had early menopause. Is HRT different for me?
Women whose periods stop at or before 45 have a higher risk of osteoporosis, which means weak, thin bones. The Indian Menopause Society advises hormone replacement at least until the usual age of menopause, unless there is a medical reason not to.
Before you decide
Please do not start or stop HRT on your own. Your doctor can go through your age, your health and your fracture risk with you. Our guide Turning 45? Bone health questions women ask covers the other risk factors for weak bones.
For doctors
The evidence behind this page is in HRT and bone and Fracture risk in perimenopause.
Talking to a doctor in Patiala
To talk about your bone health with Dr Aditya Aggarwal, orthopaedic surgeon, call Aggarwal Clinic on +91 98768 24676.
Aggarwal Clinic, 1-E, The Mall, Patiala.
This page is general information, not medical advice. Please talk to your doctor about what is right for you.
Questions
Common questions
- Does HRT protect my bones?
- Yes, while you take it. In a large US trial, women on combined HRT had about a third fewer hip fractures, which was 5 fewer for every 10,000 women each year. The benefit fades after HRT stops.
- What are the risks of HRT?
- In the same US trial, for every 10,000 women on combined HRT each year, there were 8 more breast cancers, 8 more strokes, 8 more blood clots in the lung and 7 more heart events. Women without a womb who took oestrogen alone had no rise in breast cancer, but 12 more strokes per 10,000 women each year.
- Does my age change the balance of benefit and risk?
- Yes. The balance is better in women under 60, or within 10 years of their last period. It is worse after 60.
- Is an HRT patch or gel different from a tablet?
- HRT tablets raise the risk of blood clots. The UK bone guideline says HRT through the skin, as a patch or gel, at standard doses does not.
Last reviewed
General information only; it doesn’t replace a consultation. In an emergency, call 112.