Who should take hormone replacement therapy? Benefits and side effects

For many women, hormone replacement therapy (HRT) offers real relief during perimenopause and menopause. For most women, it’s a safe and effective treatment, but it might not be for everyone.

In this guide, we cover who should take hormone replacement therapy and who shouldn’t. If you’re wondering whether this treatment can support your unique health journey, speak to your care provider for guidance.

Starting hormone replacement therapy: When should I consider treatment?

HRT can offer support as you navigate perimenopause and menopause. You’re an ideal candidate for the treatment if you’re under the age of 60 and within 10 years of the start of menopause. This includes women who have experienced early menopause or primary ovarian insufficiency.

Perimenopause typically begins in your mid-40s (though it can start sooner). No single test can tell you if you’re in perimenopause, but key early signs include changes to your menstrual cycle and hot flashes. Once you haven’t had a period for 12 consecutive months, you officially enter menopause.

Hormone levels naturally rise and fall during perimenopause before settling at a lower baseline in menopause. The main hormones involved are estrogen and progesterone, and fluctuations in these levels are what cause the symptoms many women experience, including: 

• Hot flashes
• Vaginal dryness
• Night sweats
• Urinary urgency
• Insomnia
• Sleep quality
• Mood
• Brain fog

HRT relieves these symptoms by supplementing the hormones that the body starts to produce less of. 

Most women live well into their 70s and beyond. This means you can spend upwards of 30 years menopausal, with symptoms that have a profound effect on your quality of life. HRT offers a lifeline, especially for those struggling with menopause at work, or those acting as caregivers.

Additional benefits of HRT

As well as alleviating the symptoms listed above, the treatment has a range of other potential benefits. According to the Royal Osteoporosis Society, HRT can reduce the risk of osteoporosis and fractures. It may also play a role in preventing age-related muscle loss and provide relief for certain medical conditions, including hypogonadism and premature ovarian insufficiency (POI). 

Studies have also linked HRT with a reduction in cardiovascular disease and type 2 diabetes risk.

Risk factors to consider before starting HRT

HRT isn’t for everyone. While the overall risk of serious complications is low, HRT can increase that chance if you suffer from certain conditions, including: 

• Liver disease
• Breast cancer
• Chest pain related to less blood flow to the heart (angina)
• Blood clots
• Stroke
• Heart attacks
• High blood pressure (hypertension)
• Unexplained vaginal bleeding

Before starting treatment, your doctor will assess your full health picture to determine whether it’s safe for you.

Note: In 2025, the FDA updated its HRT guidance to take several risks off the black box warning for HRT products. These include the risks of cardiovascular disease, breast cancer, and dementia. But that doesn’t mean the risk is zero, so always have this conversation with your doctor about your specific circumstances. 

Understanding the “window of opportunity”

For most women, HRT is a safe and effective treatment if prescribed and used appropriately. When assessing risk, one factor doctors consider is the “window of opportunity.” This refers to the time period during which HRT is most effective. For most women, this is within approximately 10 years of menopause onset, or before age 60.

Starting HRT before this window closes lowers risks while maximizing benefits. Individual experiences vary, so have a conversation with your doctor if you have questions. It’s only by looking at your full health picture that care teams can make the right call for your body, so be sure to choose clinicians like Maven Clinic who provide whole-person care. 

Can HRT cause side effects?

Some women will experience side effects from HRT as their bodies adapt to the treatment. Dosage and treatment type play a role, too. Most side effects are short-lived, typically stopping within the first few months. 

Some of the most common side effects include:

• Headaches
• Diarrhea
• Nausea
• Vaginal bleeding
• Breast tenderness

Some of these issues can also look like perimenopausal or menopausal symptoms, so it’s easy to confuse the two. If you’re experiencing any side effects, speak with your doctor to establish the root cause. They’ll monitor your progress and help you manage your symptoms effectively or adjust your treatment plan if needed.

Alternatives to HRT

If you choose not to take HRT, or if the treatment is unsuitable, your doctor may recommend an alternative. There are several options, and the right choice will often depend on your symptoms and medical history. Here are a few of the most common:

• Clonidine/Fezolinetant: Clonidine is a nonhormonal prescription medication that calms the part of the brain responsible for temperature-related signals. Your doctor may recommend it for treating hot flashes. Fezolinetant is another nonhormonal medication that does the same thing, but works on a different part of the brain.
• Vaginal moisturizer: Vaginal dryness is a common symptom of menopause. Your doctor may recommend a moisturizer alongside or independent of HRT to reduce discomfort.
• Cognitive behavioral therapy: The goal of this common form of therapy is to identify negative thought patterns and replace them with more helpful ones. It may help relieve anxiety, low mood, and the severity of hot flashes by addressing underlying stress.
• Antidepressants: Various antidepressant medications can help relieve a range of symptoms, including mood instability and hot flashes, by acting on areas of the brain involved in temperature regulation. They often work hand-in-hand with CBT.
• Lifestyle changes: Your doctor may also recommend lifestyle changes. Steps like mindful dieting and routine exercise can make a meaningful difference to your health during this time. Symptom-specific actions can help, too. For example, wearing light clothing to bed may provide some relief from night sweats.

Finding specialized support with Maven Clinic

At Maven Clinic, we believe women don’t experience symptoms in isolation. We get to the root cause of what you’re feeling so we can make informed treatment decisions together.

Our hormone care program is for women in perimenopause, menopause, or post-menopause who want personalized medical guidance. Your provider will review your symptoms and health history to determine whether treatment (including HRT) is appropriate for you.

Have questions? Don’t hesitate to reach out to our support team or browse our approach to whole-person hormone care.

FAQ

What’s hormone replacement therapy?

Hormone levels (particularly estrogen and progesterone) naturally fluctuate during perimenopause and decline in menopause. These changes often result in symptoms like hot flashes, vaginal dryness, and insomnia. Hormone replacement therapy offers relief by supplementing your hormone levels. 

What are the types of HRT?

There are two main types of HRT:

• Estrogen therapy (ET): Doctors only prescribe estrogen therapy if you’ve had a hysterectomy. That’s because on its own, estrogen can cause the lining of the uterus to thicken abnormally (endometrial hyperplasia), potentially leading to endometrial cancer.
• Combined estrogen-progesterone therapy (EPT): Most women receive estrogen and progesterone together on HRT. Progesterone counters the effect of estrogen on the uterine lining when you take it alone.

How long can you safely stay on HRT?

There isn’t a fixed maximum time period—safety hinges on several factors, including your age and health status. Talk to your doctor if you’re thinking about stopping treatment. 

Why do doctors prescribe HRT for perimenopause?

Hormones naturally fluctuate during perimenopause—estrogen and progesterone, in particular. This can contribute to a range of symptoms. Doctors prescribe HRT to supplement hormone levels, providing symptom relief. 

Does hormone therapy increase the risk of breast cancer for everyone?

The overall risk of HRT causing breast cancer is low, but certain types of HRT may carry a greater risk than others. Your doctor will factor in your personal and family history before prescribing treatment.