30 October 20269 min read

HRT benefits and risks: what the evidence says

Medical Review

Medically Reviewed by Dr. Pedro Yelamo Vera, MD

Licensed Physician No. 484814280 · Official Medical College of Bizkaia (Spain)Last reviewed: 31 October 2026

HRT benefits and risks: hot flushes, bones, breast cancer, clots and stroke. What NICE says, who should avoid HRT and the options in Spain.

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HRT benefits and risks depend on your age, your health and the type of HRT. For most healthy women under 60, or within 10 years of their last period, the benefits are likely to outweigh the risks. HRT is the most effective treatment for hot flushes and protects your bones. Combined HRT slightly raises breast cancer risk. Tablets, unlike patches and gels, raise the risk of clots.

TL;DR

HRT is the most effective treatment for hot flushes and night sweats, and it lowers the risk of broken bones.
Started before 60, HRT does not raise the risk of heart disease, says NICE.
Combined HRT slightly raises breast cancer risk, more with longer use. Oestrogen-only HRT has little or no effect.
HRT tablets raise the risk of blood clots. Patches and gels at standard doses do not.
Low-dose vaginal oestrogen treats dryness and bladder symptoms with very rare side effects.
In Spain it is called terapia hormonal sustitutiva (THS) and needs a prescription.

Dr. Pedro Yelamo Vera is a GP licensed in Spain (Colegiado No. 484814280).

For a medical emergency, call 112 or go to the nearest local emergency department. Do not wait for a video consultation or an online reply.

What is HRT and what does it treat?

HRT (hormone replacement therapy) replaces the oestrogen your ovaries stop making at menopause. If you still have a womb, you also take a progestogen. This protects the lining of the womb. If you have had your womb removed, you take oestrogen alone.

HRT comes as tablets, skin patches, gels or sprays. NICE advises doctors to offer it for hot flushes and night sweats. In Spain you will hear THS and parches (patches).

What are the benefits of HRT?

Hot flushes and night sweats. Mayo Clinic calls oestrogen the most effective treatment for them.
Low mood. NICE says HRT can be considered for low mood caused by menopause.
Bones. HRT lowers the risk of broken bones while you take it. In the NICE 2024 discussion aid, 60 in 1,000 women aged 50 to 54 had a fragility fracture over 5 years. With HRT, it was 40 in 1,000.
Vaginal and bladder symptoms. Dryness, pain during sex and some bladder symptoms often improve.

The benefit to bones fades after you stop.

Does HRT raise the risk of breast cancer?

It depends on the type of HRT and how long you take it. NICE puts it this way:

Oestrogen-only HRT (for women without a womb) has little or no effect on breast cancer risk.
Combined HRT (oestrogen plus progestogen) can raise the risk. The rise grows with the years of use and falls after stopping.

The NICE 2024 discussion aid gives figures for 1,000 women followed from 50 to 69:

With no HRT, about 59 get breast cancer.
With combined HRT for 5 years from age 50, about 79 do. That is 20 more.
With combined HRT for 10 years, about 92 do. That is 33 more.
With oestrogen-only HRT for 5 years, about 69 do, which is 10 more.

These are averages for groups, not your own risk. Your family history, weight and alcohol also matter. Keep going to breast screening (mamografía).

Weighing up HRT and not sure how the risks apply to you?

You can book a video visit with a GP licensed in Spain, in English or Spanish. He goes through your symptoms, your health and family history, and explains your options in plain words.

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Does HRT cause blood clots or stroke?

The type of HRT matters most here. NICE says:

HRT tablets raise the risk of clots in the veins (DVT and pulmonary embolism).
Patches and gels at standard doses do not raise the risk above the usual level. NICE suggests them for women with a higher clot risk, such as a BMI over 30.
Stroke. Oestrogen tablets carry a small extra risk. Skin forms do not. Under 60 the starting risk is very low.

Is HRT bad for your heart?

Not when it starts before 60. NICE says HRT does not raise the risk of heart disease in women under 60. It does not change the risk of dying from it either. High blood pressure or cholesterol does not rule HRT out if they are well treated. MSD Manuals warns that starting combined HRT after 65 raises heart risk.

What about womb cancer, dementia and diabetes?

Womb (endometrial) cancer. Oestrogen alone raises this risk in women with a womb. Adding a progestogen almost removes it. Some unexpected bleeding is common in the first 3 months, says NICE.
Dementia. NICE says the effect of HRT on dementia risk is unknown. In its aid, combined HRT started at 65 or older was linked with more dementia: 18 in 1,000, against 9.
Type 2 diabetes. NICE says HRT does not raise the risk.

Who should not take HRT?

MSD Manuals says oestrogen is usually not suitable if you have had:

Breast cancer.
A blood clot in the legs or lungs.
A stroke or coronary heart disease.

Starting HRT over 60 needs more care. NICE advises that women with, or at high risk of, breast cancer see a menopause expert. Low-dose vaginal oestrogen acts locally and is unlikely to raise cancer risk, says MSD Manuals.

What if you cannot or do not want to take HRT?

Talking therapy. NICE suggests cognitive behavioural therapy (CBT) for low mood or anxiety. MSD Manuals says CBT also helps with hot flushes.
Non-hormonal medicines. Some prescription medicines reduce hot flushes, such as fezolinetant. It needs liver blood tests.
Herbal remedies are not proven, says MSD Manuals, and some can harm.

How is HRT started and checked in Spain?

HRT needs a prescription in Spain. Your GP (médico de familia) or a gynaecologist (ginecólogo) can prescribe it. NICE advises a review at 3 months, then once a year. Spain's medicines agency, the AEMPS, also advises a yearly review.

There is no fixed time limit in the NICE guideline. The AEMPS safety note from 2008 is older and more cautious: it advises limited use, for example 2 or 3 years. Your doctor weighs this with you at each yearly review. Women with menopause before 40 should usually take HRT until at least the usual age of menopause. NICE also notes that HRT is not a contraceptive.

When should you get help?

Call 112 if you have sudden shortness of breath or chest pain that is worse when you breathe in. Also call for coughing up blood, fainting, or a drooping face, a weak arm or slurred speech.

See a doctor today if one leg is swollen, painful, warm or a different colour.

Book a visit soon if you have bleeding after the first 3 months of HRT, bleeding after your periods had stopped, or a new breast lump.

Talking it through with a doctor by video

Dr. Yelamo is a GP licensed in Spain. He sees adults, children and pregnant patients by video, every day from 07:30 to 20:30 (Spain time). In the visit he will:

Ask about your symptoms, periods, health and family history.
Go through the benefits and risks of each type of HRT for you.
Agree a plan, and tell you if you need tests, a scan or an in-person exam.

He does not promise any test or prescription before the visit. Where clinically appropriate, following a genuine evaluation. Treatment and prescriptions are issued solely at the doctor's discretion based on evidence-based clinical guidelines.

A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

See how the Urgent Care video visit works. It lasts 15 minutes and costs €50.

This guide is general information. It does not replace a consultation with your doctor.

Frequently asked questions

Is HRT safe?

For most healthy women under 60, or within 10 years of their last period, the benefits of HRT are likely to outweigh the risks. The balance depends on your age, your health and the type of HRT.

Does HRT cause breast cancer?

Combined HRT (oestrogen plus progestogen) slightly raises the risk, more with longer use, and the extra risk falls after stopping. NICE says oestrogen-only HRT has little or no effect on breast cancer risk.

Are HRT patches safer than tablets?

For blood clots, yes. NICE says oral HRT raises the risk of clots, while patches and gels at standard doses do not raise it above the usual risk. Oral oestrogen also adds a small stroke risk that skin forms do not.

How long can I take HRT?

NICE sets no fixed time limit. You and your doctor review it after 3 months and then once a year. When you stop, you can taper or stop at once: in the long term, symptoms are the same either way.

Is HRT a contraceptive?

No. HRT does not prevent pregnancy. If you are under 50, or still having periods, ask your doctor what contraception you need and for how long.

Sources

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Medical Citations & Sources

This content is written and reviewed by a licensed physician with reference to the following official health authorities.