This article was written by Dr. Deyo Famuboni, Medical Doctor Specialized in women's Health, and 3mbrace Health Advisor

Imagine waking up every morning feeling like a stranger in your own body. The hot flushes, night sweats, mood swings, brain fog, and sleepless nights – not to mention the silent threat of long-term health issues like osteoporosis and cardiovascular disease. For many navigating (Peri)menopause, this is more than just a phase; it's a daily struggle. But what if there was a way to feel like yourself again?

Welcome to a deep dive into Hormone Replacement Therapy – a modern, evidence-based approach to managing menopause and thriving. Whether you're newly menopausal, perimenopausal, or supporting someone on this journey, understanding HRT can be transformative.

What Is HRT?

HRT, also known as Menopause Hormone Therapy (MHT), is the administration of hormones – primarily oestrogen and progesterone – to improve symptoms associated with the decline in reproductive hormones during menopause. Originally developed in the 1970s using animal-derived hormones, today’s HRT is far more advanced, predominantly plant-based, using extracts from sources like soya and wild yams.

How Does It Work?

HRT works by restoring oestrogen and, where necessary, progesterone and testosterone to levels that maintain function in parts of our bodies including the brain, bones, skin, and cardiovascular system. For those with a uterus, progesterone is essential to protect the inner lining of the womb (endometrium ) from becoming too thick due to the effects of oestrogen. In some cases, testosterone may also be added to support libido. Studies and anecdotal reports suggest it can help with energy.

Types of HRT

There are several formulations:

• Oestrogen-only HRT: For individuals without a uterus.
• Combined HRT (oestrogen and progesterone): For those with a uterus.
• Sequential or continuous: Based on your stage in menopause. Sequential HRT is used if you still have periods and continuous if the periods have stopped.
• Local vs systemic: Vaginal oestrogens for local symptoms vs transdermal or oral options for systemic effects.
• Topical vs oral HRT: Topical HRT are generally considered safer and have very few contraindications as it bypasses the liver. They come in patches, gels and creams.

What Symptoms Can HRT Treat?

HRT helps with the following:

• Hot flushes and night sweats
• Vaginal dryness and discomfort
• Sleep disturbances
• Mood changes and anxiety
• Joint aches
• Cognitive fog
• Loss of libido

And many more. It not only improves quality of life but can also restore confidence and wellbeing.

What Long-Term Conditions Does HRT Help Prevent?

Research suggests HRT plays a protective role in:

• Bone Health (Osteoporosis): By maintaining bone mineral density.
• Cardiovascular health: If HRT is started before age 60 or within 10 years of menopause.
• Type 2 Diabetes and central obesity: Improved insulin sensitivity has been observed.
• Dementia and cognitive decline: Emerging evidence suggests a potential neuroprotective effect when started early.

Bioidentical vs Compounded HRT: What’s the Difference?

• Pharmaceutical-grade bioidentical HRT: Also known as Body identical HRT. They are regulated, standardised, evidence-based and are manufactured by major pharmaceutical industries. Derived from plant sources, these are chemically identical to the exact structure of human hormones.  Side effects are well documented and often mild.
• Compounded bioidentical HRT: Custom-mixed, plant derived substances that mimic the body’s natural hormones. They are often available in private clinics, are promoted as natural or personalised, and not regulated in the same way. There is insufficient evidence regarding their efficacy and safety, and they lack the rigorous quality control and clinical testing of licensed options. Side effects are difficult to predict and inconsistencies in dosage may occur.

The British Menopause Society and the North American Menopause Society advise against compounded versions due to safety concerns.

Are There Any Risks and or side effects with HRT?

Yes – but they’re often misunderstood. Modern HRT, especially transdermal oestrogen and micronised progesterone, has a more favourable safety profile than older preparations.

• Short-term risks: Mild bloating, breast tenderness, or irregular bleeding. These tend to be mild and usually settle within 3 months.
• Long-term risks: A very small increased risk of breast cancer with combined  HRT (but less than the risk associated with being overweight or consuming alcohol). The risk of clots (venous thromboembolism) is no greater than the baseline risk generally with newer topical HRT. Endometrial cancer risk is decreased by adding progesterone to oestrogen.  Ovarian cancer risk is slightly increased only if used longterm and disappears within a few years of stopping. 

Importantly, given the current evidence and studies available, the benefits outweigh the risks for most women under 60 or within 10 years of menopause onset.

Final thoughts

Women often describe HRT as life-changing. Beyond symptom relief, they experience renewed energy, better sleep, stable moods, and a greater sense of control over their health. It’s not just about getting through menopause – it’s about thriving.

Taking the time to understand your options, tracking symptoms, and discussing personalised treatment with a menopause-informed healthcare provider is the first step. The investment is in your long-term health (healthspan), independence, and quality of life.

Menopause is a natural transition, but being alone and suffering through it is not. HRT is not about bringing back your past self – it's about stepping into a vibrant, empowered chapter of life. Speak with your GP or a menopause specialist to see if it’s right for you. You deserve to feel like you are living your best life.

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