When I first heard about Hormone Replacement Therapy (HRT), my mind went straight to one word: cancer.
It’s a fear many of us have. We’ve all heard the headlines. But as I learned from my conversation with Dr Annie Middleton, a GP and menopause expert, the truth is far more nuanced and far less scary.
The Million Women Study and the Panic It Caused
In the early 2000s, a huge UK study called the Million Women Study made headlines, claiming HRT significantly increased breast cancer risk.
“That study frightened an entire generation,” Dr Annie explained.
“Women came off HRT overnight, and doctors became reluctant to prescribe it.”
But here’s the thing the study had major flaws. Most participants were much older than the typical HRT patient. Subsequent research has shown the increased breast cancer risk is small.
How Small Are We Talking?
“For every thousand women on HRT, there may be five extra cases of breast cancer compared to women not taking it,” Dr Annie told me. “That’s actually less risk than having a glass of wine every night.”
I laughed and then paused. I’d never questioned my nightly red wine, but I had been scared of HRT for years.
Perspective really does matter.
What HRT Actually Does
HRT replaces the hormones mainly oestrogen and sometimes progesterone and testosterone, that naturally decline during menopause. It can:
- Reduce hot flushes and night sweats
- Improve sleep
- Boost mood and brain function
- Help maintain bone density and heart health
It’s not just about symptom relief. For some women, it’s also a long-term health investment.
Not All HRT Is the Same
There are two main types Dr Annie discussed:
- Body Identical HRT (available on the NHS)
- Regulated, well-studied, precise dosages
- Delivered via skin patches, gels, or sprays (lower blood clot risk)
- Often combined with progesterone if you still have a womb
- Bioidentical HRT (private clinics)
- Marketed as “natural” but unregulated
- Inconsistent dosages and absorption
- Not recommended by the British Menopause Society
“Some women think bioidentical means safer,” Dr Annie said. “In reality, it can be less effective and less safe.”
Vaginal Oestrogen Cream, A Hidden Gem
Not ready for full HRT? Vaginal oestrogen cream is a game changer for dryness, discomfort, and urinary issues.
“It’s available over the counter now,” Dr Annie told me. “Safe for almost everyone, no absorption into the bloodstream.”
It’s simple, effective, and something I wish I’d known about years ago.
Is HRT Right for You?
HRT isn’t for everyone. Women with certain health conditions, like active breast cancer, may need alternatives. But for the vast majority, the benefits outweigh the risks, especially if started in your 40s or 50s.
The real takeaway? Don’t let fear stop you from exploring your options. Get the facts, weigh the pros and cons with your GP, and make a decision based on your life, not someone else’s headlines.
🎧 Listen Now
Dr Annie Middleton busts myths and explains exactly how to navigate the HRT conversation with your doctor.
–Written by Host Hala Ali
The Visionary with Hala Ali Podcast 