Is hormone therapy safe?

"HRT is too risky for anyone."

What the evidence actually says

The Menopause Society's view, in short: for women under 60, or within 10 years of menopause, with no reason to avoid it, the benefits for bothersome hot flashes, night sweats and bone loss outweigh the risks.

Source: The Menopause Society, 2022 position statement. Your clinician goes through your own risks.

In plain terms, The Menopause Society's 2022 position statement says three things:

• Timing matters. For women under 60, or within 10 years of their last period, with no reason to avoid it, the balance is favourable for bothersome hot flashes and night sweats, and for preventing bone loss.
• Later is different. Starting after 60, or more than 10 years after menopause, the balance is less favourable.
• "Hormone therapy" isn't one thing. Risks depend on the type, the dose, how long you take it, how it's taken and when you start.

That last point is why the question "is HRT safe?" doesn't have a yes-or-no answer for everyone. It has a pretty clear answer for you, once someone has gone through your history.

Why it's the first-line treatment

Canada's obstetrician-gynaecologist society, the SOGC, calls hormone therapy the most effective treatment for hot flashes and night sweats. Ontario Health's menopause quality standard notes that guidelines recommend menopause hormone therapy as the first-line treatment for those symptoms, and that many clinicians report hesitation about prescribing it.

Source: SOGC Guideline No. 422a (2021); Ontario Health, Menopause Quality Standard.

So if you've been told it's too risky to even discuss, that may say more about the hesitation than about you.

When the answer is no

Hormone therapy isn't right for everyone. Some histories, like breast cancer, a blood clot or a stroke, mean going carefully or not at all. That's not the end of the conversation: non-hormonal prescription options exist for hot flashes and night sweats.

Source: SOGC Guideline No. 422a (2021).

Does "bioidentical" make it safer?

No. "Bioidentical" describes the molecule. It doesn't mean natural, and it doesn't mean safer. Body-identical hormones are available in Health Canada approved prescription products. Custom-compounded "BHRT" is a different thing: The Menopause Society lists concerns about dosing, purity and missing safety data.

Source: SOGC, Menopause and U; The Menopause Society, 2022 position statement.

Some things don't wait for an appointment

Bleeding after menopause, or a new breast lump: contact a clinician promptly or call Health811 (811). Chest pain, sudden weakness or stroke signs: call 911.