Thought HRT Probably Wasn’t for Me. Until My Body Had Other Ideas
This post contains affiliate links. If you buy something through them, I may earn a small commission — at no extra cost to you. I only ever link to things I've actually used and genuinely rate.
I always knew HRT existed. I filed it away under “probably not for me” and got on with things. Well, that was until my body and mind had other ideas.
The sleepless nights I could almost explain away. The joint pain I put down to getting older. But then came the weight gain, the hair loss, the blood pressure that seemed to arrive from nowhere and a fog so thick that some days I genuinely wondered if something was seriously wrong with me.
Nobody connected it to hormones. For a while, neither did I. Then something clicked. Maybe just maybe I had reached the stage of life when I needed to think seriously about hormone replacement therapy.
Why was everyone so frightened of HRT?
When I started researching HRT, I walked straight into a wall of conflicting information, outdated assumptions and decades of fear. Once you understand where some of that fear came from, the anger is difficult to shake.
In 2002, early findings from the Women’s Health Initiative usually referred to as the WHI changed the conversation about HRT almost overnight. The study reported increased risks of breast cancer, heart disease and stroke with a particular type of combined hormone therapy.
Women stopped taking HRT. Prescribing fell dramatically. The frightening headlines travelled much further than the details. Those details mattered.
The women taking part were, on average, older than the women who would usually begin HRT for menopause symptoms, and many were more than a decade beyond menopause. The WHI also contained separate trials: one looked at combined oestrogen and progestogen in women who still had a womb, while another looked at oestrogen alone in women who had undergone a hysterectomy.
HRT was discussed as though it were one treatment with one universal level of risk. It isn’t.
Long-term follow-up produced a far more nuanced picture. In the WHI trial, oestrogen-only treatment was associated with a reduction in breast-cancer diagnoses and deaths. Combined oestrogen and progestogen was associated with an increased risk of breast-cancer diagnosis, although not a statistically significant increase in breast-cancer mortality.
That doesn’t mean HRT is risk-free or suitable for everyone. It means the type of HRT, the hormones used, how they are taken, when treatment begins and a woman’s individual medical history all matter.
The British Menopause Society says HRT prescribed before the age of 60 generally has a favourable benefit–risk profile. The decision should still be individual and made after discussing the potential benefits and risks with a healthcare professional.
The science became more nuanced. The fear, unfortunately, proved much harder to shift.
Being heard shouldn’t feel like a battle
Many women still describe walking into a short GP appointment with a list of symptoms and leaving without menopause being properly discussed. Some are offered antidepressants or referred for talking therapy without first having the wider hormonal picture explored.
Those treatments may be appropriate and helpful for some women. The problem is not that they exist. The problem is when menopause isn’t considered at all.
Perimenopause can last for years, and its effects can reach into sleep, mood, concentration, relationships, work and physical health. Women deserve enough time, information and support to understand what may be happening to them.
Two books changed everything for me: Menopausing by Davina McCall with Dr Naomi Potter—I know Davina isn’t everyone’s cup of tea, but the book is well researched and worth reading—and The Definitive Guide to the Perimenopause and Menopause by Dr Louise Newson.
Read them. Take notes. Write down your symptoms. Go to your GP prepared.
HRT isn’t one thing
Something worth understanding before an appointment is that HRT isn’t a single treatment. There are different hormones, doses, combinations and ways of taking them. What is appropriate will depend on your symptoms, whether you still have your womb, your stage of menopause, your medical history and your preferences.
Oestrogen
Oestrogen is the main hormone replaced by HRT. It can be taken as a tablet or absorbed through the skin using a patch, gel or spray.
Tablets can slightly increase the risk of blood clots, although the overall risk remains small. According to the NHS guide to HRT types, patches, gels and sprays do not increase that risk, so transdermal oestrogen may be a more suitable option for some women.
Progestogen and progesterone
If you still have your womb, you will normally need a progestogen alongside oestrogen. This protects the womb lining and reduces the risk of endometrial cancer.
It might be taken as a separate capsule or provided through an intrauterine system such as the Mirena coil, which releases the progestogen levonorgestrel locally.
Micronised progesterone is often described as body-identical because it has the same molecular structure as the progesterone produced by the body. Observational evidence suggests it may be associated with a lower breast-cancer risk than some older synthetic progestogens, particularly with shorter-term use. However, it would be misleading to describe any form of systemic HRT as entirely risk-free. Risk depends on the combination used, the duration of treatment and the individual woman.
Testosterone
Testosterone is another hormone affected by menopause, but it isn’t routinely prescribed for every symptom.
Current NHS guidance says a specialist may consider testosterone for postmenopausal women experiencing low sexual desire when HRT alone hasn’t helped. Research into whether it improves symptoms such as mood, energy and motivation is still developing, and more evidence is needed.
It is usually prescribed as a gel in a very low dose. If low libido remains a problem despite HRT, it may be worth asking whether testosterone is something you should discuss.
Finding the right treatment can take time
Every woman’s HRT will look different. Doses may need adjusting, and something that works at the beginning may need changing later. That is normal. It isn’t a failure.
When it was my turn, I went to my GP ready for a fight. I had written down my symptoms and knew I wasn’t leaving until I felt heard.
I was lucky, really bloody lucky.
My GP referred me directly to a gynaecologist. There was a wait, but when I eventually saw the consultant, I was started on HRT without an argument or a battle. I know that isn’t every woman’s experience, and that is one of the reasons I feel so strongly about this.
About eight weeks after starting HRT, things began to improve. It hasn’t been entirely straightforward, though. You don’t slap on a patch or rub in some gel and suddenly watch every symptom disappear. I still experience symptoms. My treatment needs monitoring and sometimes adjusting. What works can change as my body changes. That isn’t a reason for me to avoid HRT. It is simply the truth I wish somebody had told me at the beginning.
You are not going mad
Advocate for yourself. Learn about your options. And hear this: you are not going mad.
The racing heart. The itching, OMG, the bloody itching. The hair loss. The anxiety that seems to arrive from nowhere. The brain fog. Hip pain that wakes you at 3am. Forgetting what you were saying while you are still saying it. The rage the full red-mist rage. The overwhelming desire to factory-reset yourself and feel human again.
All of these symptoms can occur during perimenopause and menopause. They can also have other causes, which is why new, persistent or worrying symptoms deserve a proper medical assessment rather than being automatically blamed on hormones.
Your body deserves proper support, not dismissal.
Go to your GP. Read reliable information. Take your symptom notes. Ask questions. Push back respectfully if you don’t feel heard, and request another opinion when necessary.
You know when something has changed in your body. Trust yourself enough to ask for help.
This article shares my personal experience and is not medical advice. HRT is not suitable for everyone. Discuss your symptoms, personal and family medical history, and the potential benefits and risks with a GP or qualified menopause specialist.
Loretta x
P.S. If this resonates, you might also find comfort in my free 5-day Thrive Reset, covering sleep, overwhelm and understanding your changing body after 50. One honest email a day from someone who's lived it.
