8 misconceptions about using HRT for menopause

What you’ll learn:   

• Misconceptions about HRT’s risks and effects, including breast cancer concerns and beliefs that it causes weight gain, stem from outdated or limited studies.
• By balancing estrogen levels, HRT can help with classic menopause symptoms like hot flashes, mood swings, and night sweats.
• While HRT won’t help you lose weight, it can help redistribute fat away from the belly. 

During menopause, fluctuating hormones can feel like your body is completely resetting—and in many ways, it is. As estrogen levels drop, your body must adjust to life without this essential hormone. Estrogen doesn’t just regulate reproduction; it influences body temperature, mood, bone density, muscle health, and cardiovascular function. Its decline can disrupt these systems, leading to symptoms like hot flashes, night sweats, mood swings, and weight gain, particularly around your belly.

While what you eat, how you move, getting enough sleep, and reducing stress can help, those moves do not replace the hormones that are disrupting your body. Hormone replacement therapy (HRT) can bring relief from classic menopause symptoms like hot flashes, night sweats, and mood swings. It can also prevent some chronic conditions associated with menopause, such as osteoporosis, cardiovascular disease, and vaginal atrophy, while supporting overall bone and muscle health as you age. Note that HRT is also sometimes called menopause hormone therapy (MHT) or just hormone therapy (HT), but they refer to the same treatments.

However, HRT often raises questions and concerns due to persistent myths about its risks, including links to cancer and weight gain. Conflicting information has made navigating menopause even more confusing.

In this article, we’ll debunk common misconceptions about HRT, explore recent research, and explain its diverse effects and options. With accurate insights, you can better assess whether HRT is the right tool for managing your menopause symptoms and achieving your long-term health goals. 

The phases of menopause

First, let’s break menopause down into its distinct phases because HRT is prescribed differently, and its safety changes depending on where you are in the process. Here’s a quick look at what happens during each phase:

• Perimenopause: This phase typically begins in your 40s and leads up to menopause. It occurs as your ovaries gradually decrease estrogen production, leading to irregular periods and symptoms like hot flashes. These hormonal shifts can also contribute to weight gain.
• Menopause: When periods have stopped for 12 consecutive months, you have reached menopause. This happens on average at age 51 in the U.S.
• Postmenopause: After menopause, your hormone levels stabilize at a lower level. 

HRT can be prescribed during any phase, but the types and forms can vary depending on where you are in the journey. Let’s go through the most common myths to understand why.

Common myths about using HRT for menopause

HRT often comes with a lot of questions and misunderstandings. From fears about cancer risk to misconceptions about its safety and effectiveness, myths surrounding HRT can make it hard to separate fact from fiction. By breaking down these common concerns—like the idea that HRT is unnatural, causes weight gain, or isn’t necessary for managing menopause—you’ll have the information you need to make informed decisions about your health.

HRT Myth 1: HRT increases the risk of cancer, especially breast cancer

You’ve probably heard a lot about HRT and breast cancer risk, and it’s likely because of the Women’s Health Initiative (WHI) study. This study was one of the first to raise red flags about HRT and the potential risks for breast cancer and heart issues. But there’s more to the story than those initial headlines let on.

The WHI study wasn’t perfect, and some key details didn’t get the attention they deserved:

• Media misinterpretation: Initial media reports oversimplified the WHI’s findings, often ignoring these limitations and differences in HRT types, which caused widespread misconceptions about HRT risks.
• Age and timing: Most participants were in their early 60s, over a decade past menopause. We now know that this late start to HRT can influence how the body reacts, making it difficult to apply these results to women who start HRT closer to menopause.
• Focus on specific formulations: The WHI primarily studied one type of HRT—combined estrogen and progestin therapy, using specific formulations. This narrow focus doesn’t cover other HRT types, like estrogen-only therapy, bioidentical formulations, and topical applications, which may have different risk profiles.
• High dropout rates: Nearly 40% of participants discontinued treatment during the study. This high dropout rate raises questions about the data’s reliability, as it may have skewed the results.
• Selection bias: Only a small percentage of the screened women agreed to participate, so the study’s findings may not fully represent the broader population of postmenopausal women.

Since the WHI study, more research has helped clear things up. Here’s what we now understand:

• Timing of HRT: Starting HRT closer to menopause (around ages 50 to 59) generally comes with fewer risks and might even provide some protective benefits.
• Type matters, too (see Myth 2 below): Estrogen-only therapy, especially for women who’ve had a hysterectomy, typically shows a lower risk of breast cancer than combined therapies. Also, the risk was exaggerated, with the absolute risk of breast cancer remaining low even in the patient taking the combination therapy.

So, when is HRT a good choice? These days, experts agree that HRT can be both safe and beneficial when tailored to a person’s needs. For many who start HRT around the beginning of menopause, it can provide significant relief from symptoms and support long-term bone health. Staying in regular contact with a healthcare provider is also key, as it ensures that HRT remains the best fit for you and allows for adjustments as your needs change.

HRT Myth 2: There’s only one type of HRT

A variety of HRT options are available, each tailored to different needs and health profiles. Many assume only one type exists, but HRT options vary significantly in purpose, effectiveness, and potential risks and benefits. Here’s a quick look at the main types:

• Estrogen-only therapy: Best for women without a uterus, it helps alleviate hot flashes, vaginal dryness, and prevents bone loss, though it may increase endometrial cancer risk if the uterus is intact.
• Combined estrogen and progesterone therapy: Suitable for women with a uterus, this combination provides symptom relief while protecting the uterine lining but may slightly increase breast cancer and cardiovascular risks with long-term use. More recent data around the use of bioidentical progesterones may mitigate this risk.
• Low-dose options: Low-dose hormone therapy, available in estrogen-only and combined forms, can provide effective symptom relief with potentially fewer risks. These options are often recommended for people who require a lower hormone level to manage symptoms while minimizing potential side effects. Products like estradiol patches, gels, creams, and oral tablets or combined therapy options like estrogen with progesterone are commonly available in low-dose formulations to suit individual needs and preferences.

HRT also comes in several formats, so you can find the one that best fits your lifestyle. A healthcare provider will help you identify the option that aligns with your personal health goals and needs.

• Pills – Easy to take and widely used, oral pills release hormones gradually, providing steady symptom relief. However, they are processed by the liver, which can increase clotting risks in some people.
• Patches – Applied to the skin, patches release hormones directly into the bloodstream, bypassing the liver and potentially lowering clot risk. They are convenient for consistent release over time.
• Gels and creams – Gels and creams are applied to the skin and allow more control over hormone dosing. They are ideal for women sensitive to other forms of HRT or who prefer flexible dosing.
• Sprays – Hormone sprays are applied to the skin, usually on the forearm, and deliver a precise dose of hormones directly into the bloodstream. They’re quick-drying, convenient, and discreet, ideal for women who prefer a no-mess alternative to gels or creams.

Myth 3: You don’t need medical help for menopause

Some believe that because menopause is a “natural” stage, it doesn’t require medical intervention. While it’s true that menopause is a normal part of aging, the symptoms that come with it can take a toll on how you feel day-to-day, and it’s okay to take something to make you feel better.

In addition to HRT, GLP-1 medications are also available to support weight management during menopause, helping address metabolic shifts that commonly occur. Seeking medical help for menopause isn’t about resisting a natural process; it’s about finding the right tools to manage this transition comfortably and healthily.

If you want to know more about how a GLP-1 medication could benefit you, see if you qualify for Noom Med. Our clinicians can determine which medication is right for you and prescribe it if needed. 

Myth 4: HRT is unnatural

Some people believe hormone replacement therapy (HRT) is “unnatural” or disrupts the body’s natural aging process. This perception stems from the fact that, in the past, HRT often used synthetic hormones or hormones derived from the urine of pregnant mares (conjugated equine estrogens). Understandably, these sources raised concerns about how well the therapy aligned with the body’s needs.

But today’s HRT options are quite different. A safety and efficacy review found that FDA-approved bioidentical hormone therapy—designed to closely mimic hormones naturally produced by the body—is a safe treatment option for menopausal women. When used correctly and monitored by a doctor, the benefits of hormone therapy can often outweigh the potential risks.

Today, bioidentical hormones are widely available and closely regulated. Synthetic progesterones (progestins) are used less often now for hormone replacement, but they are still used in other treatments. Progestins are often used to treat bleeding, uterine pre-cancers, and cancers and are the hormone found in birth control. Bioidentical progesterone (referred to as micronized progesterone or MP) is generally the first-line treatment. 

When prescribed appropriately, HRT offers relief from menopause symptoms with minimal risk. Working with a healthcare professional can help ensure that HRT is a safe and effective choice for your needs.

Myth 5: Natural treatments are more effective and safer than HRT

The belief that “natural” equals safer often leads people to prefer plant-based treatments over synthetic hormones. Marketing reinforces this idea, portraying natural remedies as risk-free alternatives. However, most herbal supplements lack robust scientific evidence to support their effectiveness, with mixed study results that leave their true benefits uncertain.

While personal testimonials and influencer endorsements may boost their appeal, these anecdotes don’t replace scientific research. It’s important to remember that “natural” doesn’t always mean safe. Herbal supplements can cause side effects, interact with medications, and vary in quality due to inconsistent regulation. Always consult your doctor before starting any treatment to ensure it’s both safe and effective for your needs. HRT is extensively studied and proven effective at relieving menopause symptoms like hot flashes, night sweats, and vaginal dryness.

Myth 6: HRT causes weight gain

The belief that HRT causes weight gain likely stems from common misconceptions. Menopause brings metabolic changes, a slower metabolism, and shifts in fat distribution, especially around the abdomen. When women start HRT during this time, it’s easy to link weight gain to the therapy instead of the usual changes of aging and hormonal shifts. Additionally, early studies on HRT didn’t always distinguish between menopause-related weight gain and HRT use, reinforcing the perception that HRT causes weight gain. 

Most recent research does not support this connection. A review of several clinical trials found no significant difference in weight gain between women using HRT and those who didn’t. 

Even more encouraging, a review of 10 studies showed that most HRT regimens don’t lead to weight gain. While one specific combo was linked to a slight increase, other combinations actually showed weight loss. 

Another study found that women on HRT gained about two pounds less over three years compared to those taking a placebo. So, while everyone’s body reacts differently, HRT may help keep some extra weight at bay.

Myth 7: HRT is only for women who want short-term symptom relief

While HRT is often used to reduce symptoms like hot flashes, night sweats, mood swings, and sleep issues, it can have far-reaching effects. 

HRT has been linked to a lower risk of fractures in the hip, spine, and other bones, making it useful for preventing osteoporosis. Ongoing research shows that HRT helps slow bone loss, which is especially important as estrogen levels drop during menopause. 

Some studies have found that HRT is associated with a reduced risk of gastrointestinal cancers, including colorectal cancer. This contrasts with the increased risks associated with breast and ovarian cancers, highlighting the nuanced effects of HRT on cancer risk.

So it’s not just about easing symptoms—it’s also about protecting your long-term health.

Myth 8: My life will never be the same after menopause

Menopause doesn’t have to mean losing the life you love. Today, it’s seen as a time of renewal, with more options than ever to help you feel energized and in control. HRT can help ease symptoms, allowing you to enjoy this stage fully and feel balanced and strong. 

With HRT and a few healthy lifestyle adjustments, menopause can actually be a fresh start—a time to focus on your well-being, set new goals, and embrace life with confidence. Far from holding you back, this stage can empower you to feel your best and continue doing what you love.

Integrating HRT with Noom for effective menopause management

While past studies and persistent myths may have created confusion, current research shows that HRT can be a safe and effective option. With the right type, dosage, and timing, HRT can help alleviate symptoms and even help protect against long-term health risks like osteoporosis and cardiovascular disease.

It’s also important to remember that managing menopause involves more than just addressing hormonal changes. Your overall lifestyle plays a key role. Regular physical activity, a balanced diet rich in whole foods, adequate hydration, and stress-reduction techniques like yoga or meditation can amplify the benefits of HRT and improve your quality of life. Noom can help you integrate all of these into a balanced program. 

If you qualify for Noom Med, your clinician can decide if GLP-1 medications might be right for you in coordination with HRT. If prescribed, these medications can help reduce hunger and may help you lose weight. If cost is an issue, your clinician can also prescribe compounded semaglutide* if needed. This medication contains the same active ingredient as Ozempic^® and Wegovy^® but starts at just $149 per month. See if you qualify. 

Think of HRT as one piece of a larger puzzle. When combined with healthy habits, a supportive mindset, and complementary treatments, if needed, it can be a powerful part of your menopause toolkit. Ultimately, menopause is a transition, not the end of feeling vibrant and strong. With the right approach, you can embrace this stage with confidence, ensuring that you stay active, healthy, and ready to enjoy everything life has to offer.