If you’ve moved through menopause with few (or very minor) symptoms, you might wonder whether hormone replacement therapy (HRT) is really necessary.
As one listener put it when writing to our podcast, Age Better, “I’m one of the lucky ones.” No hot flushes, no night sweats, good energy levels and a strong, healthy lifestyle, so where does HRT fit in?
Here, Liz reveals the surprising ways that HRT can support us through midlife and beyond.
Menopause symptoms aren’t always obvious
“When we think about menopause symptoms, we often think about hot flushes,” Liz says. “Night sweats, mood changes, sleep disruptions. Those are the most common.”
But declining oestrogen doesn’t always show up in such obvious ways. Liz points out that menopausal symptoms can be lesser known: achy joints, stiffness, headaches, recurrent UTIs, dry eyes, tinnitus, itchy skin, vaginal dryness, digestive upsets, thinning hair or low mood.
“Because these symptoms can creep in gradually,” she explains, “many of us in later life don’t label them as menopause symptoms at all. We just think, ‘Well, that’s just ageing, isn’t it?’”
What HRT actually replaces
“HRT is fabulous, and it is the only thing that will replace missing oestrogen,” says Liz. “I often say this, and it’s really simple. How do you replace lost oestrogen? By replacing lost oestrogen.”
Lifestyle habits matter, but they don’t replace hormones themselves. “There is no other magic way to do that,” Liz adds. “We can, however, absolutely support the body in other ways.”
For Liz, HRT is a key part of her routine. She uses it alongside strength training, good nutrition, sleep and stress management to feel her best.
Bone health: a key reason to consider HRT
One of the strongest arguments for considering HRT is bone health.
After menopause, bone loss accelerates, particularly in the first five to 10 years.
“HRT is one of the most effective ways we have of slowing bone loss and reducing fracture risk,” says Liz.
For women with a family history of osteoporosis, this becomes especially relevant. “HRT isn’t just for symptom control,” Liz says. “It can also be part of a longer-term strategy to protect bone density.”
Can HRT be prescribed without symptoms?
Short answer? Yes.
“HRT doesn’t have to be prescribed only for hot flushes,” Liz explains. “Current guidance allows it to be considered for the prevention of osteoporosis, especially where there’s an increased risk.”
A good starting point is a conversation with your GP about bone density, fracture risk and family history. A DEXA scan may also be helpful in building a clearer picture.
Liz notes that a menopause specialist (either privately or within the NHS) can be helpful in finding out if HRT is the right approach.
And, when it comes to bones, it’s important to know that HRT alone isn’t a cure-all.
“Strength training, walking, nutrition, lifestyle – all of these play a huge role in protecting bones,” says Liz. “HRT can be the icing.”
Got a question for Liz?
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