The Truth About HRT And Its Risks: Evaluating Modern Research

hrt menopause Mar 04, 2025

Hormone Replacement Therapy (HRT) has long been a topic of debate, particularly since the release of the Women’s Health Initiative (WHI) study in 2002. That study initially linked HRT to increased risks of breast cancer, heart disease, and blood clots, causing widespread fear and a sharp decline in HRT use. However, in the years since, researchers have taken a closer look at the data and conducted new studies — many of which have debunked those early conclusions.

Today, leading menopause experts agree that HRT, when used appropriately, is much safer than previously believed and offers significant health benefits. From protecting heart and brain health to reducing osteoporosis risk, modern research is reshaping the conversation around HRT.

In this article, you will learn:

Why the WHI study’s findings were flawed and have since been reinterpreted
The latest evidence on HRT’s role in heart, bone, and brain health
How newer HRT formulations minimize risks and maximize benefits

For a deep dive into how the WHI got it so very wrong > be sure to check out part one of this article here.

Let’s dive into the science and uncover the truth about HRT.

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Modern Research: The Safety and Benefits of HRT

In the years following the WHI study, scientists began reanalyzing the data and conducting new research. What they found contradicted many of the initial fears about HRT, and almost all of the initial findings have been walked back.

Today, most menopause experts agree that HRT is much safer than previously thought and provides numerous health benefits when used appropriately.

Dr. Avrum Bluming, a breast oncologist, has been at the forefront of challenging misconceptions about HRT. His research and writings highlight:

The WHI study’s flaws and misinterpretations—including the fact that estrogen alone did not increase breast cancer risk.
The protective benefits of estrogen, including its role in heart health, bone strength, and cognitive function.
How modern formulations and delivery methods of HRT reduce risks compared to older treatments.

Bluming argues that the fear surrounding HRT has done more harm than good, preventing women from receiving treatment that could improve their quality of life and long-term health. (1,2)

Here are some of the key findings of more modern research.

Blood Clot Risk is Lower with Transdermal Estrogen

Early HRT formulations were taken orally, which slightly increases the risk of blood clots.

Newer transdermal (patch, cream, gel, or spray) estrogen does not carry the same clotting risks because it bypasses the liver and does not increase clotting factors in the bloodstream.

HRT and Breast Cancer: The Real Story

The WHI study overstated the breast cancer risk, especially for estrogen-only therapy.

The absolute increase in risk was tiny—less than 0.1% per year.

Newer analyses show no increased risk with bioidentical HRT (estradiol and micronized progesterone). (3)

HRT and Heart Health: Timing Matters

If HRT is started within 10 years of menopause, it may lower the risk of heart disease by keeping arteries more flexible. (4)

Women who start HRT later in life (after 60-65) may not get the same heart benefits, but they also don’t appear to face major risks if properly monitored.

Cognitive Health: Can Estrogen Protect Against Dementia?

Studies suggest estrogen may help protect brain function and could possibly reduce Alzheimer’s risk, especially when started early in menopause. (5)

Women who undergo surgical menopause (removal of ovaries) at a young age and don’t take HRT have a higher risk of dementia. (6)

Bone Health and Osteoporosis Prevention

Estrogen helps maintain bone density, reducing the risk of fractures and osteoporosis.

Women who avoid HRT may face a higher risk of hip fractures later in life.

Why the Medical Community is Changing Its Stance on HRT

With these newer findings, leading medical organizations now support the use of HRT for most healthy women going through menopause:

> The North American Menopause Society (NAMS) states that HRT is safe and beneficial for women under 60 or within 10 years of menopause onset. (7)

> The British Menopause Society and The Menopause Charity emphasize that the benefits outweigh the risks for most women. (8)

> The Endocrine Society and International Menopause Society both recognize that previous fears were overstated and encourage evidence-based HRT use. (9,10)

As myths are being debunked, more women are regaining access to HRT and experiencing the benefits.

Debunking The Biggest HRT Myths

Despite the overwhelming scientific evidence supporting HRT, many myths persist, causing unnecessary fear and hesitation among women and healthcare providers.

Let’s break down the most common misconceptions and uncover the truth behind them.

Myth #1: HRT Causes Blood Clots and Stroke

The reality: transdermal estrogen does not appear to increase clot risk

One of the most well-known fears about HRT is that it increases the risk of blood clots and strokes. This belief stems from the WHI study, which found a slight increase in venous thromboembolism (VTE) — a condition where blood clots form in veins.

However, modern research has shown that this risk depends on how estrogen is delivered.

Oral estrogen (taken in pill form) passes through the liver, which can slightly increase clotting factors.

Transdermal estrogen (patches, gels, sprays, creams) bypasses the liver entirely and does not increase clot risk. (11)

Myth #2: HRT Increases the Risk of Breast Cancer

The reality: the risk was overstated and newer research disputes it

The WHI study reported a small increase in breast cancer risk for women using combined HRT (estrogen + progestin). However, later analyses found major flaws in the study’s conclusions.

The absolute risk increase was tiny—just 8 additional cases per 10,000 women per year.

The increase was seen only in women using synthetic progestins, not in those using bioidentical progesterone.

Women who took estrogen-only therapy (for those who had a hysterectomy) actually had a lower breast cancer risk compared to non-users.

Myth #3: HRT Causes Heart Disease

The reality: HRT can be heart-protective if started early

The WHI study originally suggested that HRT might increase the risk of heart disease. However, researchers now recognize that this was due to the study’s flawed design.

Most of the women in the WHI study were over 60 when they started HRT—many already had existing heart disease risk factors.

Newer studies show that starting HRT within 10 years of menopause (typically before age 60) can actually reduce the risk of heart disease.

Estrogen keeps blood vessels flexible, reduces inflammation, and helps regulate cholesterol levels — all of which benefit heart health. (12)

Myth #4: Only Women With Severe Menopause Symptoms Need HRT

The reality: HRT provides long-term health benefits beyond symptom relief

Many women believe that HRT is only for those with severe hot flashes and night sweats, but the benefits go far beyond symptom relief:

Bone Health: Estrogen is critical for bone health. As levels wane, it can impact risk of fractures and osteoporosis.
Brain Health: Estrogen is crucial for your brain health, and plays a role in mood and cognition. Without ample levels of it circulating in your body, we can see depression, brain fog, and a troubling ‘emotional flatness’ in women. This is one of the sneakier signs of low estrogen.
Heart Health: Estrogen helps maintain cardiovascular health by keeping your tissues juicy and flexible. Since heart disease is the number one killer of women, we need to consider the role this hormone plays in heart health.
Urogenital Health: Estrogen doesn’t just keep your heart and blood vessels at their best, it also keeps your vaginal, urethral, and bladder tissues plump and strong. This helps stave off vaginal atrophy, dryness, and painful intercourse, as well as urinary tract infections.

This is why many doctors are now recognizing that HRT is not just about treating symptoms — it’s about long-term health and disease prevention.

Even women with mild menopause symptoms could consider HRT for its long-term protective benefits on bones, heart, and brain health.

Myth #5: HRT is Risky for All Women

The reality: most healthy women can likely take HRT

For years, women were routinely denied HRT because doctors believed it was too risky.

However, modern guidelines from menopause and endocrine experts now state that most healthy women under 60 (or within 10 years of menopause) can safely take HRT.

What’s more, HRT should be personalized — the type, dose, and delivery method should be tailored to each woman’s needs. Some women may only need a tiny bit of estrogen to get the relief they need.

Women with certain conditions (such as hormone-sensitive breast cancer or endometriosis) may need alternatives, but HRT should not automatically be off-limits for these women.

What This Means for the Future of HRT

As more research emerges, the future of HRT looks promising.

Here’s what we can hope for:

More Doctors Becoming Educated on HRT

Medical schools and training programs are slowly updating their menopause education.

More doctors are learning about bioidentical hormones, transdermal estrogen, and individualized treatment plans.

The stigma around HRT is slowly fading, and doctors are becoming more open to prescribing it.

A Shift Towards Personalized HRT Treatments

Not all women need the same dose or type of HRT — customized treatments are becoming more common.

More providers are recognizing the importance of transdermal estrogen to reduce clotting risks.

The use of bioidentical progesterone is growing as an alternative to synthetic progestins.

Better Public Awareness and Advocacy

Organizations like The Menopause Charity and The British Menopause Society are actively dispelling myths and providing women with accurate information.

Social media is empowering women to demand better menopause care. Be sure to follow me on Instagram for more of this kind of information!

More women are challenging their doctors when they receive outdated advice about HRT.

Continued Research on HRT and Long-Term Health

Scientists are investigating HRT’s potential role in preventing Alzheimer’s disease.

More studies are being conducted on HRT’s effects on heart disease and metabolic health.

Researchers are exploring how HRT could be used to improve mental health and prevent depression in menopausal women.

What You Can Do Moving Forward

Despite the progress being made, many women still struggle to access accurate information and proper treatment. Here’s how you can take control of your menopause health:

Educate Yourself

Read evidence-based sources and check any facts you see on social media. Dr. Bluming has a wonderful book called Estrogen Matters that you should definitely check out.

Be cautious of misleading media headlines that continue to spread outdated fears about HRT.

Advocate For Yourself

If your doctor refuses to prescribe HRT based on outdated information, ask for a second opinion.

Request an HRT specialist or menopause-trained doctor if necessary.

Look for a naturopathic doctor. Need help finding one? I’ll walk you through the process > here.

Consider Your Personal Risk Factors

HRT is not one-size-fits-all. What works for one woman may not be ideal for another.

If you have a history of blood clots, consider transdermal estrogen instead of oral.

If you’ve had a hysterectomy, estrogen-only HRT may be an option.

Join Menopause Support Groups & Communities

Online communities can provide support and shared experiences with other women navigating HRT and menopause. Linking up with other women who are going through the same thing as you can be such a powerful experience!

Women today have more access to information than ever before, but the fight isn’t over. The next step is widespread education, for both doctors and patients, to ensure that no woman is denied safe, effective menopause treatment due to outdated myths.

If you’ve been avoiding HRT due to fear, now may be the right time to take a fresh look at the science. Consult a knowledgeable doctor, explore your options, and make the best decision for your health and future.

References

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