Is Hormone Replacement Therapy Safe? Learn What the Latest Research Says

For women going through menopause, hormone replacement therapy (HRT) can be a game-changer. It helps manage symptoms like hot flashes, night sweats, mood swings, and even bone loss, and it’s helped many of our patients at Creekside Family Practice.

However, over the years, HRT has been subject to some controversy. Is it safe? What about the risk of cancer or heart disease? And how does bioidentical HRT compare to conventional HRT?

New research sheds light on these questions, helping healthcare providers and patients make informed decisions. Our board-certified physician, Hammad Qureshi, MD,  breaks it down in simple terms.

Understanding HRT: Conventional vs. bioidentical

HRT is a treatment that provides hormones — mainly estrogen and progesterone — to replace those the body stops making during menopause. There are two main types:

Conventional HRT

These are FDA-approved synthetic or animal-derived hormones found in pills, patches, gels, or injections.

Bioidentical HRT (BHRT)

BHRT hormones are chemically identical to the ones our bodies naturally produce. They come from plant sources, like soy or yams, so they are often marketed as a more natural option. They are typically tiny, long-acting implants that we inject under your skin. BHRT is available in customized forms through compounding pharmacies.

Here are just a few examples of what the latest research on HRT safety shows

Cancer risk

One of the biggest concerns with HRT is its potential link to cancer, particularly breast cancer. A major study in 2002, called the Women’s Health Initiative (WHI), raised alarms about a slight increase in breast cancer risk with certain types of HRT. However, recent research suggests a more nuanced picture.

A 2023 review in The Lancet found that the risk depends on the type of HRT and how long you use it. Combination therapy (estrogen plus progesterone) appears to increase the risk of breast cancer slightly, but estrogen-only treatment has a lower risk.

Studies also indicate that bioidentical hormones may have a lower risk profile. Still, a comprehensive review in Menopause (the Journal of the Menopause Society) advises that more large-scale studies are needed to confirm this.

Heart health

There was once concern that HRT increased the risk of heart disease, but newer research is changing that view. According to a 2024 Progress in Cardiovascular Diseases study, starting HRT when ovarian function ceases could reduce the risk of heart disease and stroke.

Estrogen has protective effects on blood vessels, and some experts now believe that timing matters, so using HRT earlier rather than later may be beneficial for heart health.

Bone health

Menopause leads to bone loss, increasing the risk of osteoporosis and fractures. There’s already plenty of evidence that HRT helps to maintain bone density. Now, a 2021 study in Bone Reports confirms that HRT remains one of the most effective treatments for preventing osteoporosis-related fractures, particularly in women at high risk.

Brain health

Many women worry about cognitive decline or dementia as they age. Some early research suggests that estrogen may help protect brain function, but findings are mixed.

A 2023 report from Alzheimer’s Research & Therapy found that HRT may result in a lower risk of Alzheimer’s in certain women, particularly those who start it early. However, more research is needed to confirm if HRT can reliably protect against memory loss.

Science continues to evolve, and ongoing research will help provide even clearer answers.

What this means for you

The latest research shows that HRT — both conventional and bioidentical — can be safe and effective when used appropriately. Though there are risks, the benefits often outweigh them, especially with personalized therapy tailored to the individual.

If you’re considering HRT, we help you make a decision that’s based on your personal health history and symptoms. We discuss the benefits and risks and evaluate alternatives; for example, lifestyle changes, dietary adjustments, and non-hormonal treatments can also help manage menopause symptoms.

If you’re unsure about HRT, having an open conversation with us at Creekside Family Practice is the best first step, so call our office or fill in the online inquiry form. Medicine isn’t one-size-fits-all, and your menopause treatment should be as unique as you are!